Internet Retailer: Marketing Conference/Exhibition June 2007

	Yes! I want a free subscription to IRNewsLink. *
	No.

You are signing up for a free subscription to IRNewsLink, which includes four newsletter editions weekly and periodic product and service bulletins of interest to those in the Internet retailing industry. Please answer all questions completely.

In lieu of a signature, we require a unique identifier to be used only to verify this subscription request.

On which day of the month were you born? *

I. ADDRESS

Please list your name, title, company and business address below (no P.O. boxes, please).

First Name *		State / Province *
Last Name *		Zip / Postal Code *
Title *		Country *
Company *		Phone
Street Address *		Fax
Suite / Floor		Email*
City *		Confirm Email *

II. INDUSTRY *

Which category best describes your industry? (Choose only one)

	Retail Chain or Store
	Catalog/Direct Merchant
	Internet Service
	Virtual Merchant / Web Retailer
	University/School/Library
	Consultant
	Manufacturer
	Wholesaler / Distributor
	Other

III. RETAIL TYPE *

If you answered Retail Chain or Store above, please specify what type: (Choose only one)

	Department Store/General Merchandiser
	Discount
	Specialty
	Food/Drug
	Home Center/Hardware
	Other

IV. JOB FUNCTION *

Please indicate your primary job function: (Choose only one)

	Interactive/Network Services
	MIS / Operations
	Database Services
	Marketing
	Merchandising
	Fulfillment/Inventory Management
	Financial Management
	Executive
	E-Commerce / E-Business
	Other

V. TITLE *

Please indicate your title: (Choose only one)

	Chairman/CEO/President/COO
	EVP/SVP
	CIO
	CFO
	VP
	Director/Department Manager
	Other

* Required