Company Listing Information  Company Code (existing companies):  (For your company code please refer to the preprinted questionnaire, if unavailable leave blank. Example: Company Code: 123456-0000)  Name of Company:  Division:  Street Address:  PO Box:  PO Box Zip Code:  City:  State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Guam Puerto Rico Virgin Island Alberta British Columbia Labrador Manitoba New Brunswick Newfoundland Northwest Territory Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory  Zip Code:  Province:  Country:  Phone:  Fax:  800 number:  E-Mail Address:  Web Site (URL):  Contact_Name:  Title:  Please check the box here if you are interested in advertising in the Buyers Guide. We will have a sales representative contact you.  Category List: Please indicate product categories listed below that are appropriate for your company with a check in the box. Career Recruitment & Staffing - Career Recruitment & Staffing Clinical Packaging - Labeling - Packaging - Safety - Transportation Consulting - Consulting CROs (Place a check in the box only if a CRO) - General - Medical Device - Niche - Phase I-IV Contract Research Services - CRF Design - CT Protocol Design - Data Collection - Data Monitoring - Health Metrics - Medical Writing - Negotiating Budgets/Contracts - Pharmacovigilance Information Technology - CTMS - EDC (PDAs, ediaries) - IVRs - Software Program Development - Other IRBs - IRBs Laboratories (Place a check in the box only if a laboratory) - Bianalytical - Biomarkers - Cardiovascular - ECG - Central - Core - Imaging Laboratory Supplies - Laboratory Supplies Subject Recruitment - Subject Recruitment Training & Education - Training & Education Other Services & Products - Other Services & Products  This form has been completed by:  Name :  Title:  E-mail:  Fax:  Date Completed:  Please remove our company name from your list, we do not wish to be included in the Directory.  Please in the future DO NOT FAX this questionnaire, but mail it instead. Advanstar Communications provides certain customer contact data (such as customers’ names, addresses, phone numbers and e-mail addresses) to third parties who wish to promote relevant products, services and other opportunities which may be of interest to you. If you do not want Advanstar Communications to make your contact information available to third parties for marketing purposes, simply call 888-527-7008 between the hours of 7:30 am and 5:00 pm and follow the instructions to remove your name from Advanstar’s lists OR check the box below. Remove company name from third party lists © 2009 Advanstar Communications Inc.