Name:
Title:
Company:
Address:
City:	State: Zip:
Country:
Phone:
Fax:
E-Mail:
Website URL:
Check the category which best describes your company or work: Ad Agency Museum Pharmaceutical Company Design Firm Medical Publisher (Text/Journal) Medical Product Manufacturer General Publisher (Book/Magazine) Multimedia/Animation Communications/Marketing Other
How many times a year do you assign: Medical Illustration Natural Science Illustration Medical Photography Multimedia/Animation Projects
Your responsibility level for assigning projects: Select One All Some None
Have you received previous editions of the Medical Illustration Source Book? Select One Yes No
I refer to the Source Book: Select One Daily Weekly Monthly for the purposes of finding Illustrators and/or Photographers for:
Assignment Work Stock Images Ideas & Inspiration Medical Reference Style Reference
Please list the names of some artists you have hired for assignments in the last 12 months:
How valuable do you find the Medical Illustration Source Book compared to other source books for making project assignments: Select One Low Moderate Very Valuable
How many times a year do you buy the following: Stock Images Royalty Free Images