Four (4) issues including the annual CM Industry Directory. Free Subscription for qualified applicants. All subscriptions are at the discretion of the publisher. (Valid only for Canadian-based subscribers. US & International Subscriptions are $55 year each and will be invoiced).0Contact Details1First Name*2Last Name*3Title*4Company*5Address 1*Street Address6Address 2*Apt, Unit, Suite, etc.7City*8Postal or Zip*9Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-bissauGuyanaHaitiHeard Island And Mcdonald IslandsHoly See (vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic OfIraqIrelandIsraelItalyJamaicaJapanJordanKazakstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, The Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre And MiquelonSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province Of ChinaTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.s.Wallis And FutunaWestern SaharaYemenZambiaZimbabwe10Province or State*Outside Canada or US--CANADIAN PROVINCESAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest Territories*Nova ScotiaNunavut*OntarioPrince Edward IslandQuebecSaskatchewanYukon Territory*--US STATESAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming11Phone*12Fax*13Email Address*14Mother's Maiden Name*15Business Details16Your organization's annual sales volume in $Millions*017Our company markets in*check all that applyCanadaUnited StatesInternationally18Job Function19Please indicate one primary job function and as many secondary job functions as apply:*PrimarySecondaryNot ApplicableSenior Corporate Management (President, CEO, Chairman, Etc)Corporate Contact Center Director/ManagerRegional or Branch Contact Center SupervisorCustomer Service/Support ManagementContact Center TrainerSales/Marketing Director/ManagerIT/CIO/IS and other Technology ManagementHelp Desk ManagementCSR/TSR/AgentLive/Web Help SpecialistCFO/ControllerTelemarketing/Sales/Fundraising ManagementCredit/Collections ManagementCRM ManagementTelecommunications/Operations/Data ManagementOrder Desk Management & SupportSystems Analyst/Systems Integration/Engineering Support20Primary Business Type*Manufacturing High Tech Equipment and/or SoftwareComputer or Telecom VAR, VAD, etc RetailWholesaling or Distribution Package Goods and Mass Consumer ServicesFinancial Services (banks, insurance, credit, investment) Publisher/SubscriptionGovernment, Economic Development Tourism & TravelMajor UtilitiesEntertainmentNon-Profit, Charity, Cultural Group, etc. Education (college, university, etc)Telecom Provider Consulting, Advisor, Training, InvestmentCable, Teleservices Advertising, Marketing, Market ResearchAviation Online services, including ISPHealth Care Web Marketing / Online Advertising NetworkGovernment, Economic Development, other public serviceCredit/CollectionsIn-house Contact Centre Customer Service/Product Support DeskDispatch/Emergency Answering ServiceOutsource Service Bureau Field ServiceHelp DeskOther21Number of Locations*drag it022Number of Seats*drag it023I Approve24I specify, recommend, approve, purchase or influence the purchase of:*Check all that applyACD Speech RecognitionCRM Association MembershipWorkforce Management Staffing, Training & EducationCTI Performance OptimizationWireless Site SelectionWallboards/Displays Hosted Call Centre AppsIP Telephony Web Apps/Live AgentFurnishings Staffing & TrainingConsulting Services Content ManagementHeadsets Home Agent ApplicationseLearning SecurityMailing Lists Courier & Delivery ServicesFulfillment services VoIP ServicesCredit Card Processing Telecom Services Payment Services Other25Please send more Info*RegardingAdvertising in Contact ManagementRenting the Contact Management mailing listWriting in Contact ManagementAdvertising on the Direct Marketing website26Do you wish to receive news announcements free via email from Contact Management and/or our advertisers?*YesNo27I undertand that I must renew my subscription from time to time (at no charge) and I can withdraw my consent to unsubscribe from the mailing list at any time*Yes, I want a FREE subscription to Direct Marketing (12 issues per year) and signup to receive emails .28I would also like to have my company listed in the Contact Management Industry directory.*Please send me a listing form and more information.29FOR U.S. or INTERNATIONAL SUBSCRIBERS ONLY30Subscriptions for US residents are $55.00US per year. (If you are non-Canadian based and you complete this form without this section, you will not receive any issues.)31Payments Details*Bill MeI'm mailing a cheque32Purchase Order #*33Make cheque out to Lloydmedia, Inc. and mail to: 302-137 Main Street North Markham, ON L3P 1Y234Submit35
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