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Submitted URL: http://safelinks.protection.outlook.com/?url=https%3A%2F%2Fforms.haymarketsubscribe.com%2FMMM_New%26pk%3DWEBCAST22%3FelqTrackId%3D355f79...
Effective URL: https://forms.haymarketsubscribe.com/loading.do?elqTrackId=355f7968694e4957b9e0aec31b10ea0d&elq=09f956d723584b91ad8c6755cef7305e&elqa...
Submission: On June 21 via api from US — Scanned from DE
Effective URL: https://forms.haymarketsubscribe.com/loading.do?elqTrackId=355f7968694e4957b9e0aec31b10ea0d&elq=09f956d723584b91ad8c6755cef7305e&elqa...
Submission: On June 21 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST saveNewSubscription.do;jsessionid=D78B6D82876056F003C5401C07173932
<form method="post" accept-charset="utf-8" action="saveNewSubscription.do;jsessionid=D78B6D82876056F003C5401C07173932" id="standardForm"><input type="hidden" name="14" id="14" value="1"><input type="hidden" id="dragonjsessionid"
name="dragonjsessionid" value="D78B6D82876056F003C5401C07173932"><input type="hidden" id="omedasite" name="omedasite" value="MMM_New"><input type="hidden" id="shippingaddresscountry" name="shippingaddresscountry" value="7">
<div class="container">
<header class="sixteen columns">
<div id="bannerimg"><img src="https://hostedcontent.dragonforms.com/hosted/images/dragon/12424/247.png"></div>
<div id="blurb"><img src="https://hostedcontent.dragonforms.com/hosted/images/dragon/12424/138.png"></div>
</header>
<section class="sixteen columns contentmiddle">
<ul class="validation">
</ul>
<input name="demo12341" type="hidden" value="WEBCAST22" id="demo12341"><input name="demo12342" type="hidden" value="343" id="demo12342"><input name="demo12343" type="hidden" value="1000" id="demo12343">
<hr>
<p id="p1" class="drg-element-type-standard-field drg-element-sub-type-fieldname-FIRSTNAME addresslabel"><span class="questionlabel "><label for="id1">First Name</label> </span><input class="drg-field-address-normal" name="demo12345"
type="text" value="" id="id1" maxlength="40" size="40" placeholder="First Name " title="First Name "></p>
<p id="p2" class="drg-element-type-standard-field drg-element-sub-type-fieldname-LASTNAME addresslabel"><span class="questionlabel "><label for="id2">Last Name</label> </span><input class="drg-field-address-normal" name="demo12346" type="text"
value="" id="id2" maxlength="40" size="40" placeholder="Last Name " title="Last Name "></p>
<p id="p10" class="drg-element-type-standard-field drg-element-sub-type-fieldname-TITLE addresslabel"><span class="questionlabel "><label for="id10">Job Title</label> </span><input class="drg-field-address-normal" name="demo12347" type="text"
value="" id="id10" maxlength="40" size="40" placeholder="Job Title " title="Job Title "></p>
<p id="p3" class="drg-element-type-standard-field drg-element-sub-type-fieldname-COMPANY addresslabel"><span class="questionlabel "><label for="id3">Company</label> </span><input class="drg-field-address-normal" name="demo12348" type="text"
value="" id="id3" maxlength="40" size="40" placeholder="Company " title="Company "></p>
<p id="p4" class="drg-element-type-standard-field drg-element-sub-type-fieldname-ADDRESS addresslabel"><span class="questionlabel "><label for="id4">Address 1</label> </span><input class="drg-field-address-normal" name="demo12349" type="text"
value="" id="id4" maxlength="255" size="255" placeholder="Address 1 " title="Address 1 "></p>
<p id="p5" class="drg-element-type-standard-field drg-element-sub-type-fieldname-DEPARTMENT addresslabel"><span class="questionlabel "><label for="id5">Address 2</label> </span><input class="drg-field-address-normal" name="demo12350"
type="text" value="" id="id5" maxlength="255" size="255" placeholder="Address 2 " title="Address 2 "></p>
<p id="p6" class="drg-element-type-standard-field drg-element-sub-type-fieldname-CITY addresslabel"><span class="questionlabel "><label for="id6">City</label> </span><input class="drg-field-address-normal" name="demo12351" type="text" value=""
id="id6" maxlength="100" size="100" placeholder="City " title="City "></p><span class="spanc8 drg-element-type-standard-field drg-element-sub-type-fieldname-STATE">
<p id="p8" class="drg-element-type-standard-field drg-element-sub-type-fieldname-STATE addresslabel"><span class="questionlabel "><label for="id8">State/Province</label> </span><select name="demo12352" id="id8"
title="State/Province ">
<option value="">State/Province </option>
<option value="1" [-selected12352_r1-]="">ALABAMA</option>
<option value="2" [-selected12352_r2-]="">ALASKA</option>
<option value="3" [-selected12352_r3-]="">ARIZONA</option>
<option value="4" [-selected12352_r4-]="">ARKANSAS</option>
<option value="5" [-selected12352_r5-]="">CALIFORNIA</option>
<option value="6" [-selected12352_r6-]="">COLORADO</option>
<option value="7" [-selected12352_r7-]="">CONNECTICUT</option>
<option value="8" [-selected12352_r8-]="">DELAWARE</option>
<option value="9" [-selected12352_r9-]="">DISTRICT OF COLUMBIA</option>
<option value="10" [-selected12352_r10-]="">FLORIDA</option>
<option value="11" [-selected12352_r11-]="">GEORGIA</option>
<option value="12" [-selected12352_r12-]="">HAWAII</option>
<option value="13" [-selected12352_r13-]="">IDAHO</option>
<option value="14" [-selected12352_r14-]="">ILLINOIS</option>
<option value="15" [-selected12352_r15-]="">INDIANA</option>
<option value="16" [-selected12352_r16-]="">IOWA</option>
<option value="17" [-selected12352_r17-]="">KANSAS</option>
<option value="18" [-selected12352_r18-]="">KENTUCKY</option>
<option value="19" [-selected12352_r19-]="">LOUISIANA</option>
<option value="20" [-selected12352_r20-]="">MAINE</option>
<option value="21" [-selected12352_r21-]="">MARYLAND</option>
<option value="22" [-selected12352_r22-]="">MASSACHUSETTS</option>
<option value="23" [-selected12352_r23-]="">MICHIGAN</option>
<option value="24" [-selected12352_r24-]="">MINNESOTA</option>
<option value="25" [-selected12352_r25-]="">MISSISSIPPI</option>
<option value="26" [-selected12352_r26-]="">MISSOURI</option>
<option value="27" [-selected12352_r27-]="">MONTANA</option>
<option value="28" [-selected12352_r28-]="">NEBRASKA</option>
<option value="29" [-selected12352_r29-]="">NEVADA</option>
<option value="30" [-selected12352_r30-]="">NEW HAMPSHIRE</option>
<option value="31" [-selected12352_r31-]="">NEW JERSEY</option>
<option value="32" [-selected12352_r32-]="">NEW MEXICO</option>
<option value="33" [-selected12352_r33-]="">NEW YORK</option>
<option value="34" [-selected12352_r34-]="">NORTH CAROLINA</option>
<option value="35" [-selected12352_r35-]="">NORTH DAKOTA</option>
<option value="36" [-selected12352_r36-]="">OHIO</option>
<option value="37" [-selected12352_r37-]="">OKLAHOMA</option>
<option value="38" [-selected12352_r38-]="">OREGON</option>
<option value="39" [-selected12352_r39-]="">PENNSYLVANIA</option>
<option value="40" [-selected12352_r40-]="">RHODE ISLAND</option>
<option value="41" [-selected12352_r41-]="">SOUTH CAROLINA</option>
<option value="42" [-selected12352_r42-]="">SOUTH DAKOTA</option>
<option value="43" [-selected12352_r43-]="">TENNESSEE</option>
<option value="44" [-selected12352_r44-]="">TEXAS</option>
<option value="45" [-selected12352_r45-]="">UTAH</option>
<option value="46" [-selected12352_r46-]="">VERMONT</option>
<option value="47" [-selected12352_r47-]="">VIRGIN ISLANDS</option>
<option value="48" [-selected12352_r48-]="">VIRGINIA</option>
<option value="49" [-selected12352_r49-]="">WASHINGTON</option>
<option value="50" [-selected12352_r50-]="">WEST VIRGINIA</option>
<option value="51" [-selected12352_r51-]="">WISCONSIN</option>
<option value="52" [-selected12352_r52-]="">WYOMING</option>
<option value="53" [-selected12352_r53-]="">American Samoa</option>
<option value="54" [-selected12352_r54-]="">Guam</option>
<option value="56" [-selected12352_r56-]="">Micronesia (Federated States of)</option>
<option value="58" [-selected12352_r58-]="">Puerto Rico</option>
<option value="59" [-selected12352_r59-]="">U.S. Minor Outlying Islands</option>
<option value="60" [-selected12352_r60-]="">NORTHERN MARIANA ISLANDS</option>
<option value="61" [-selected12352_r61-]="">Armed Forces Africa</option>
<option value="62" [-selected12352_r62-]="">Armed Forces Americas AA (except Canada)</option>
<option value="63" [-selected12352_r63-]="">Armed Forces Canada</option>
<option value="64" [-selected12352_r64-]="">Armed Forces Europe AE</option>
<option value="65" [-selected12352_r65-]="">Armed Forces Middle East AE</option>
<option value="66" [-selected12352_r66-]="">Armed Forces Pacific AP</option>
<option value="67" [-selected12352_r67-]="">ALBERTA</option>
<option value="68" [-selected12352_r68-]="">NOVA SCOTIA</option>
<option value="69" [-selected12352_r69-]="">BRITISH COLUMBIA</option>
<option value="70" [-selected12352_r70-]="">ONTARIO</option>
<option value="71" [-selected12352_r71-]="">MANITOBA</option>
<option value="72" [-selected12352_r72-]="">PRINCE EDWARD ISLAND</option>
<option value="73" [-selected12352_r73-]="">NEW BRUNSWICK</option>
<option value="74" [-selected12352_r74-]="">QUEBEC</option>
<option value="75" [-selected12352_r75-]="">NEWFOUNDLAND</option>
<option value="76" [-selected12352_r76-]="">SASKATCHEWAN</option>
<option value="77" [-selected12352_r77-]="">NORTHWEST TERRITORIES</option>
<option value="78" [-selected12352_r78-]="">YUKON TERRITORY</option>
<option value="79" [-selected12352_r79-]="">NUNAVUT</option>
<option value="1002" [-selected12352_r1002-]="">FOREIGN</option>
</select></p>
</span>
<p id="p9" class="drg-element-type-standard-field drg-element-sub-type-fieldname-ZIP addresslabel"><span class="questionlabel "><label for="id9">Zip/Postal Code</label> </span><input class="drg-field-address-normal" name="demo12353" type="text"
value="" id="id9" maxlength="9" size="9" placeholder="Zip/Postal Code " title="Zip/Postal Code "></p><span class="spanc7 drg-element-type-standard-field drg-element-sub-type-fieldname-COUNTRY">
<p id="p7" class="drg-element-type-standard-field drg-element-sub-type-fieldname-COUNTRY addresslabel"><span class="questionlabel "><label for="id7">Country</label> </span><select name="demo12354" id="id7" title="Country ">
<option value="">Country </option>
<option value="80" [-selected12354_r80-]="">UNITED STATES</option>
<option value="81" [-selected12354_r81-]="">CANADA</option>
<option value="84" [-selected12354_r84-]="">AFGHANISTAN</option>
<option value="86" [-selected12354_r86-]="">ALBANIA</option>
<option value="87" [-selected12354_r87-]="">ALGERIA</option>
<option value="89" [-selected12354_r89-]="">ANDORRA</option>
<option value="90" [-selected12354_r90-]="">ANGOLA</option>
<option value="91" [-selected12354_r91-]="">ANGUILLA</option>
<option value="350" [-selected12354_r350-]="">ANTARCTICA</option>
<option value="92" [-selected12354_r92-]="">ANTIGUA</option>
<option value="93" [-selected12354_r93-]="">ARGENTINA</option>
<option value="94" [-selected12354_r94-]="">ARMENIA</option>
<option value="95" [-selected12354_r95-]="">ARUBA</option>
<option value="96" [-selected12354_r96-]="">ASCENSION IS</option>
<option value="97" [-selected12354_r97-]="">AUSTRALIA</option>
<option value="98" [-selected12354_r98-]="">AUSTRIA</option>
<option value="99" [-selected12354_r99-]="">AZERBAIJAN</option>
<option value="101" [-selected12354_r101-]="">BAHAMAS</option>
<option value="102" [-selected12354_r102-]="">BAHRAIN</option>
<option value="103" [-selected12354_r103-]="">BANGLADESH</option>
<option value="104" [-selected12354_r104-]="">BARBADOS</option>
<option value="106" [-selected12354_r106-]="">BELARUS</option>
<option value="108" [-selected12354_r108-]="">BELGIUM</option>
<option value="109" [-selected12354_r109-]="">BELIZE</option>
<option value="110" [-selected12354_r110-]="">BENIN</option>
<option value="111" [-selected12354_r111-]="">BERMUDA</option>
<option value="112" [-selected12354_r112-]="">BHUTAN</option>
<option value="113" [-selected12354_r113-]="">BOLIVIA</option>
<option value="115" [-selected12354_r115-]="">BOSNIA-HERZEGOVINA</option>
<option value="116" [-selected12354_r116-]="">BOTSWANA</option>
<option value="117" [-selected12354_r117-]="">BRAZIL</option>
<option value="351" [-selected12354_r351-]="">BRITISH INDIAN OCEAN TERRITORY</option>
<option value="118" [-selected12354_r118-]="">BRITISH VIRGIN IS</option>
<option value="120" [-selected12354_r120-]="">BRUNEI</option>
<option value="121" [-selected12354_r121-]="">BULGARIA</option>
<option value="122" [-selected12354_r122-]="">BURKINA FASO</option>
<option value="123" [-selected12354_r123-]="">BURUNDI</option>
<option value="124" [-selected12354_r124-]="">CAMBODIA</option>
<option value="125" [-selected12354_r125-]="">CAMEROON</option>
<option value="127" [-selected12354_r127-]="">CAPE VERDE ISLANDS</option>
<option value="128" [-selected12354_r128-]="">CAYMAN ISLANDS</option>
<option value="129" [-selected12354_r129-]="">CENTRAL AFRICAN REP</option>
<option value="130" [-selected12354_r130-]="">CHAD</option>
<option value="134" [-selected12354_r134-]="">CHILE</option>
<option value="135" [-selected12354_r135-]="">CHINA</option>
<option value="136" [-selected12354_r136-]="">COCO ISLAND</option>
<option value="137" [-selected12354_r137-]="">COLOMBIA</option>
<option value="138" [-selected12354_r138-]="">COMOROS</option>
<option value="139" [-selected12354_r139-]="">CONGO</option>
<option value="141" [-selected12354_r141-]="">COOK ISLANDS</option>
<option value="142" [-selected12354_r142-]="">COSTA RICA</option>
<option value="143" [-selected12354_r143-]="">CROATIA</option>
<option value="144" [-selected12354_r144-]="">CUBA</option>
<option value="145" [-selected12354_r145-]="">CYPRUS</option>
<option value="146" [-selected12354_r146-]="">CZECH REPUBLIC</option>
<option value="147" [-selected12354_r147-]="">DENMARK</option>
<option value="148" [-selected12354_r148-]="">DJIBOUTI</option>
<option value="149" [-selected12354_r149-]="">DOMINICA</option>
<option value="150" [-selected12354_r150-]="">DOMINICAN REPUBLIC</option>
<option value="151" [-selected12354_r151-]="">EAST TIMOR</option>
<option value="152" [-selected12354_r152-]="">ECUADOR</option>
<option value="153" [-selected12354_r153-]="">EGYPT</option>
<option value="154" [-selected12354_r154-]="">EL SALVADOR</option>
<option value="156" [-selected12354_r156-]="">ERITREA</option>
<option value="157" [-selected12354_r157-]="">ESTONIA</option>
<option value="158" [-selected12354_r158-]="">ETHIOPIA</option>
<option value="159" [-selected12354_r159-]="">FAEROE ISLANDS</option>
<option value="160" [-selected12354_r160-]="">FALKLAND ISLANDS</option>
<option value="161" [-selected12354_r161-]="">FIJI</option>
<option value="162" [-selected12354_r162-]="">FINLAND</option>
<option value="163" [-selected12354_r163-]="">FRANCE</option>
<option value="164" [-selected12354_r164-]="">FRENCH GUIANA</option>
<option value="165" [-selected12354_r165-]="">FRENCH POLYNESIA</option>
<option value="168" [-selected12354_r168-]="">GABON</option>
<option value="169" [-selected12354_r169-]="">GAMBIA</option>
<option value="171" [-selected12354_r171-]="">GEORGIA</option>
<option value="172" [-selected12354_r172-]="">GERMANY</option>
<option value="173" [-selected12354_r173-]="">GHANA</option>
<option value="174" [-selected12354_r174-]="">GIBRALTAR</option>
<option value="176" [-selected12354_r176-]="">GREECE</option>
<option value="177" [-selected12354_r177-]="">GREENLAND</option>
<option value="178" [-selected12354_r178-]="">GRENADA</option>
<option value="179" [-selected12354_r179-]="">GUADELOUPE</option>
<option value="180" [-selected12354_r180-]="">GUATEMALA</option>
<option value="181" [-selected12354_r181-]="">GUERNSEY</option>
<option value="182" [-selected12354_r182-]="">GUINEA</option>
<option value="183" [-selected12354_r183-]="">GUYANA</option>
<option value="184" [-selected12354_r184-]="">HAITI</option>
<option value="185" [-selected12354_r185-]="">HONDURAS</option>
<option value="186" [-selected12354_r186-]="">HONG KONG</option>
<option value="187" [-selected12354_r187-]="">HUNGARY</option>
<option value="188" [-selected12354_r188-]="">ICELAND</option>
<option value="189" [-selected12354_r189-]="">INDIA</option>
<option value="190" [-selected12354_r190-]="">INDONESIA</option>
<option value="191" [-selected12354_r191-]="">IRAN</option>
<option value="192" [-selected12354_r192-]="">IRAQ</option>
<option value="193" [-selected12354_r193-]="">IRELAND</option>
<option value="194" [-selected12354_r194-]="">ISLE OF MAN</option>
<option value="195" [-selected12354_r195-]="">ISRAEL</option>
<option value="196" [-selected12354_r196-]="">ITALY</option>
<option value="197" [-selected12354_r197-]="">IVORY COAST</option>
<option value="198" [-selected12354_r198-]="">JAMAICA</option>
<option value="199" [-selected12354_r199-]="">JAPAN</option>
<option value="200" [-selected12354_r200-]="">JORDAN</option>
<option value="201" [-selected12354_r201-]="">KAZAKHSTAN</option>
<option value="202" [-selected12354_r202-]="">KENYA</option>
<option value="204" [-selected12354_r204-]="">KIRIBATI</option>
<option value="206" [-selected12354_r206-]="">KUWAIT</option>
<option value="207" [-selected12354_r207-]="">KYRGYZSTAN</option>
<option value="208" [-selected12354_r208-]="">LAOS</option>
<option value="209" [-selected12354_r209-]="">LATVIA</option>
<option value="210" [-selected12354_r210-]="">LEBANON</option>
<option value="211" [-selected12354_r211-]="">LESOTHO</option>
<option value="212" [-selected12354_r212-]="">LIBERIA</option>
<option value="213" [-selected12354_r213-]="">LIBYA</option>
<option value="214" [-selected12354_r214-]="">LIECHTENSTEIN</option>
<option value="215" [-selected12354_r215-]="">LITHUANIA</option>
<option value="216" [-selected12354_r216-]="">LUXEMBOURG</option>
<option value="217" [-selected12354_r217-]="">MACAO</option>
<option value="218" [-selected12354_r218-]="">MACEDONIA</option>
<option value="219" [-selected12354_r219-]="">MADAGASCAR</option>
<option value="221" [-selected12354_r221-]="">MALAWI</option>
<option value="222" [-selected12354_r222-]="">MALAYSIA</option>
<option value="223" [-selected12354_r223-]="">MALDIVES</option>
<option value="224" [-selected12354_r224-]="">MALI</option>
<option value="225" [-selected12354_r225-]="">MALTA</option>
<option value="226" [-selected12354_r226-]="">MARSHALL ISLANDS</option>
<option value="227" [-selected12354_r227-]="">MARTINIQUE</option>
<option value="228" [-selected12354_r228-]="">MAURITANIA</option>
<option value="229" [-selected12354_r229-]="">MAURITIUS</option>
<option value="230" [-selected12354_r230-]="">MAYOTTE</option>
<option value="231" [-selected12354_r231-]="">MEXICO</option>
<option value="232" [-selected12354_r232-]="">MICRONESIA</option>
<option value="233" [-selected12354_r233-]="">MOLDOVA</option>
<option value="235" [-selected12354_r235-]="">MONACO</option>
<option value="236" [-selected12354_r236-]="">MONGOLIA</option>
<option value="237" [-selected12354_r237-]="">MONTENEGRO</option>
<option value="238" [-selected12354_r238-]="">MONTSERRAT</option>
<option value="239" [-selected12354_r239-]="">MOROCCO</option>
<option value="240" [-selected12354_r240-]="">MOZAMBIQUE</option>
<option value="241" [-selected12354_r241-]="">MYANMAR</option>
<option value="242" [-selected12354_r242-]="">NAMIBIA</option>
<option value="243" [-selected12354_r243-]="">NAURU</option>
<option value="244" [-selected12354_r244-]="">NEPAL</option>
<option value="245" [-selected12354_r245-]="">NETHERLAND ANTILLES</option>
<option value="246" [-selected12354_r246-]="">NETHERLANDS</option>
<option value="248" [-selected12354_r248-]="">NEW CALEDONIA</option>
<option value="249" [-selected12354_r249-]="">NEW GUINEA</option>
<option value="250" [-selected12354_r250-]="">NEW ZEALAND</option>
<option value="251" [-selected12354_r251-]="">NICARAGUA</option>
<option value="252" [-selected12354_r252-]="">NIGER</option>
<option value="253" [-selected12354_r253-]="">NIGERIA</option>
<option value="254" [-selected12354_r254-]="">NORTH KOREA</option>
<option value="256" [-selected12354_r256-]="">NORWAY</option>
<option value="257" [-selected12354_r257-]="">OMAN</option>
<option value="259" [-selected12354_r259-]="">PAKISTAN</option>
<option value="260" [-selected12354_r260-]="">PALAU</option>
<option value="261" [-selected12354_r261-]="">PALESTINE</option>
<option value="262" [-selected12354_r262-]="">PANAMA</option>
<option value="264" [-selected12354_r264-]="">PARAGUAY</option>
<option value="265" [-selected12354_r265-]="">PERU</option>
<option value="266" [-selected12354_r266-]="">PHILIPPINES</option>
<option value="268" [-selected12354_r268-]="">PITCAIRN IS</option>
<option value="269" [-selected12354_r269-]="">POLAND</option>
<option value="270" [-selected12354_r270-]="">PORTUGAL</option>
<option value="271" [-selected12354_r271-]="">QATAR</option>
<option value="272" [-selected12354_r272-]="">REUNION</option>
<option value="273" [-selected12354_r273-]="">ROMANIA</option>
<option value="274" [-selected12354_r274-]="">RUSSIA</option>
<option value="275" [-selected12354_r275-]="">RWANDA</option>
<option value="276" [-selected12354_r276-]="">SAN MARINO</option>
<option value="277" [-selected12354_r277-]="">SAO TOME E PRINCIPE</option>
<option value="279" [-selected12354_r279-]="">SAUDI ARABIA</option>
<option value="281" [-selected12354_r281-]="">SENEGAL</option>
<option value="282" [-selected12354_r282-]="">SERBIA</option>
<option value="283" [-selected12354_r283-]="">SEYCHELLES</option>
<option value="284" [-selected12354_r284-]="">SIERRA LEONE</option>
<option value="285" [-selected12354_r285-]="">SINGAPORE</option>
<option value="286" [-selected12354_r286-]="">SLOVAK REPUBLIC</option>
<option value="287" [-selected12354_r287-]="">SLOVENIA</option>
<option value="288" [-selected12354_r288-]="">SOLOMON ISLANDS</option>
<option value="289" [-selected12354_r289-]="">SOMALIA</option>
<option value="290" [-selected12354_r290-]="">SOUTH AFRICA</option>
<option value="291" [-selected12354_r291-]="">SOUTH KOREA</option>
<option value="292" [-selected12354_r292-]="">SPAIN</option>
<option value="293" [-selected12354_r293-]="">SRI LANKA</option>
<option value="294" [-selected12354_r294-]="">ST CROIX</option>
<option value="295" [-selected12354_r295-]="">ST KITTS</option>
<option value="296" [-selected12354_r296-]="">ST LUCIA</option>
<option value="298" [-selected12354_r298-]="">ST MARTIN</option>
<option value="299" [-selected12354_r299-]="">ST PIERRE</option>
<option value="300" [-selected12354_r300-]="">ST VINCENT</option>
<option value="301" [-selected12354_r301-]="">SUDAN</option>
<option value="302" [-selected12354_r302-]="">SURINAME</option>
<option value="303" [-selected12354_r303-]="">SWAZILAND</option>
<option value="304" [-selected12354_r304-]="">SWEDEN</option>
<option value="305" [-selected12354_r305-]="">SWITZERLAND</option>
<option value="306" [-selected12354_r306-]="">SYRIA</option>
<option value="308" [-selected12354_r308-]="">TAIWAN</option>
<option value="309" [-selected12354_r309-]="">TAJIKISTAN</option>
<option value="310" [-selected12354_r310-]="">TANZANIA</option>
<option value="312" [-selected12354_r312-]="">THAILAND</option>
<option value="314" [-selected12354_r314-]="">TOGO</option>
<option value="315" [-selected12354_r315-]="">TONGA</option>
<option value="316" [-selected12354_r316-]="">TRINIDAD AND TOBAGO</option>
<option value="317" [-selected12354_r317-]="">TUNISIA</option>
<option value="318" [-selected12354_r318-]="">TURKEY</option>
<option value="319" [-selected12354_r319-]="">TURKMENISTAN</option>
<option value="320" [-selected12354_r320-]="">TURKS ISLAND</option>
<option value="321" [-selected12354_r321-]="">TUVALU</option>
<option value="322" [-selected12354_r322-]="">UGANDA</option>
<option value="323" [-selected12354_r323-]="">UKRAINE</option>
<option value="324" [-selected12354_r324-]="">UNITED ARAB EMIRATES</option>
<option value="749" [-selected12354_r749-]="">UNITED KINGDOM</option>
<option value="325" [-selected12354_r325-]="">URUGUAY</option>
<option value="326" [-selected12354_r326-]="">UZBEKISTAN</option>
<option value="327" [-selected12354_r327-]="">VANUATU</option>
<option value="328" [-selected12354_r328-]="">VATICAN CITY</option>
<option value="329" [-selected12354_r329-]="">VENEZUELA</option>
<option value="330" [-selected12354_r330-]="">VIETNAM</option>
<option value="332" [-selected12354_r332-]="">WALLIS ISLAND</option>
<option value="333" [-selected12354_r333-]="">WESTERN SAHARA</option>
<option value="334" [-selected12354_r334-]="">WESTERN SAMOA</option>
<option value="335" [-selected12354_r335-]="">YEMEN</option>
<option value="336" [-selected12354_r336-]="">ZAIRE</option>
<option value="337" [-selected12354_r337-]="">ZAMBIA</option>
<option value="338" [-selected12354_r338-]="">ZIMBABWE</option>
</select></p>
</span>
<p id="p11" class="drg-element-type-standard-field drg-element-sub-type-fieldname-PHONE addresslabel"><span class="questionlabel "><label for="id11">Phone</label> </span><input class="drg-field-address-normal" name="demo12355" type="text"
onkeyup="this.value = this.value.replace(/\D/g,'');" value="" id="id11" maxlength="32" size="32" placeholder="Phone " title="Phone "></p>
<p id="p13" class="drg-element-type-standard-field drg-element-sub-type-fieldname-EMAILADDR addresslabel"><span class="questionlabel "><label for="id13">Email</label> </span><input class="drg-field-address-normal" name="demo12356" type="text"
value="" id="id13" maxlength="50" size="50" placeholder="Email " title="Email "></p>
<p id="p28" class="drg-element-type-standard-field drg-element-sub-type-fieldname-EMAILADDRC addresslabel"><span class="questionlabel "><label for="id28">Confirm Email Address</label> </span><input class="drg-field-address-normal"
name="demo12357" type="text" value="" id="id28" maxlength="50" size="50" placeholder="Confirm Email Address " title="Confirm Email Address "></p><span class="spanc53 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p53" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id53">Please confirm which best describes the address type provided.</label> </span><select name="demo12358" id="id53"
title="Please confirm which best describes the address type provided. ">
<option value="">Please confirm which best describes the address type provided. </option>
<option value="494">Business</option>
<option value="495">Home</option>
<option value="496">Other (Please Specify)</option>
</select></p>
</span>
<div id="other496" class="otherfillin" style="display: none;">
<p id="p496"><span id="otherfillinid_r496" class="otherfillinlabelomeda">Other (Please Specify)</span><input name="demo12358_r496" type="text" value="" id="id_r496" maxlength="50" size="50" placeholder="Please Specify" title="Please Specify">
</p>
</div>
<hr style=" margin-bottom: 0px;"><span class="spanc9 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p9" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id9">
<table id="demotable">
<tbody>
<tr>
<td><img src="https://hostedcontent.dragonforms.com/hosted/images/dragon/12424/144.png"></td>
<td>Please check the category that best describes your company: </td>
</tr>
</tbody>
</table>
</label> </span><select name="demo12360" id="id9" title="Please check the category that best describes your company: ">
<option value="">Please check the category that best describes your company: </option>
<option value="174">Healthcare Manufacturer - Other</option>
<option value="182">Healthcare Manufacturer - Pharmaceutical</option>
<option value="183">Healthcare Manufacturer - Device/Diagnostics</option>
<option value="184">Healthcare Manufacturer - Biotech</option>
<option value="175">Advertising/Marketing/Communications</option>
<option value="176">Media Company</option>
<option value="180">Creative/Design Firm</option>
<option value="179">Market Research Firm</option>
<option value="178">Accredited CME/Education</option>
<option value="181">Healthcare Consulting Company (not incl. independent consultants)</option>
<option value="187">Technology</option>
<option value="186">Payor/PBM/Insurer</option>
<option value="185">Hospital/Health System/Medical Care</option>
<option value="188">Non-Profit/Association/Government Agency</option>
<option value="177">Business Services</option>
<option value="190">Retail/Wholesale/Distributor</option>
<option value="508">Private Equity/Investor/Finance</option>
<option value="189">Independent Consultant/Freelancer</option>
<option value="191">Other (Please Specify)</option>
</select></p>
</span>
<div id="other191" class="otherfillin" style="display: none;">
<p id="p191"><span id="otherfillinid_r191" class="otherfillinlabelomeda">Other (Please Specify)</span><input name="demo12360_r191" type="text" value="" id="id_r191" maxlength="50" size="50" placeholder="Please Specify" title="Please Specify">
</p>
</div><span class="spanc10 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p10" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id10">
<table id="demotable">
<tbody>
<tr>
<td><img src="https://hostedcontent.dragonforms.com/hosted/images/dragon/12424/145.png"></td>
<td>Which best describes your job function: </td>
</tr>
</tbody>
</table>
</label> </span><select name="demo12361" id="id10" title="Which best describes your job function: ">
<option value="">Which best describes your job function: </option>
<option value="192">Corporate Management (C-level, President, etc.)</option>
<option value="193">Marketing/Advertising Executive</option>
<option value="194">Product/Brand/Therapeutic Executive</option>
<option value="197">Media</option>
<option value="200">Creative/Design</option>
<option value="204">Public Relations/Communications</option>
<option value="195">Sales Management</option>
<option value="198">Market Research</option>
<option value="202">CME</option>
<option value="203">Managed Care</option>
<option value="199">R&D</option>
<option value="201">Regulatory Affairs/Legal Affairs/Compliance</option>
<option value="206">Technology</option>
<option value="509">Finance</option>
<option value="208">Operations</option>
<option value="205">Consulting</option>
<option value="209">Educator/Student/Intern</option>
<option value="196">Medical Director</option>
<option value="207">Medical/Scientific Affairs</option>
<option value="210">Other (Please specify)</option>
</select></p>
</span>
<div id="other210" class="otherfillin" style="display: none;">
<p id="p210"><span id="otherfillinid_r210" class="otherfillinlabelomeda">Other (Please specify)</span><input name="demo12361_r210" type="text" value="" id="id_r210" maxlength="50" size="50" placeholder="Please Specify" title="Please Specify">
</p>
</div><span class="spanc11 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p11" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id11">
<table id="demotable">
<tbody>
<tr>
<td><img src="https://hostedcontent.dragonforms.com/hosted/images/dragon/12424/146.png"></td>
<td>Please select the option that best describes your title level:</td>
</tr>
</tbody>
</table>
</label> </span><select name="demo12362" id="id11" title="Please select the option that best describes your title level: ">
<option value="">Please select the option that best describes your title level: </option>
<option value="211">C-Level</option>
<option value="212">VP/SVP/EVP</option>
<option value="213">Director</option>
<option value="214">Manager</option>
<option value="215">Non-Manager</option>
<option value="216">Other (Please specify)</option>
</select></p>
</span>
<div id="other216" class="otherfillin" style="display: none;">
<p id="p216"><span id="otherfillinid_r216" class="otherfillinlabelomeda">Other (Please specify)</span><input name="demo12362_r216" type="text" value="" id="id_r216" maxlength="50" size="50" placeholder="Please Specify" title="Please Specify">
</p>
</div>
<hr>
<div id="disp12364" style="display:none;"><span class="spanc24 drg-element-type-standard-field drg-element-sub-type-fieldname-SIGNATURE">
<p id="p24" class="drg-element-type-standard-field drg-element-sub-type-fieldname-SIGNATURE"><span class="questionlabel "><label for="id24">Would you like to receive a FREE subscription to MM&M?</label> </span><select
name="demo12364" id="id24" title="Would you like to receive a FREE subscription to MM&M? ">
<option value="">Would you like to receive a FREE subscription to MM&M? </option>
<option value="343" selected="">Yes</option>
<option value="344" [-selected12364_r344-]="">No</option>
</select></p>
</span></div>
<div id="disp12365" style="display:none;">
<hr>
</div>
<div id="newsletters">In addition to your subscription, MM+M offers email newsletters. Sign up for the newsletters below that are most relevant to you. (check all that apply)</div>
<div id="pp37" class="drg-element-type-product drg-element-sub-type-type-2"><input name="opt12367" type="checkbox" value="1" id="optp37" [-checkedopt12367-]=""><span class="questionlabel "><label for="optp37"><strong>MM+M Breaking News</strong>
- when big news hits, MM+M Breaking News alerts will deliver it straight to your inbox.</label> </span>
<div id="longp37" class="longdescopt" style="display:none"></div>
</div>
<div id="pp38" class="drg-element-type-product drg-element-sub-type-type-2"><input name="opt12368" type="checkbox" value="1" id="optp38" [-checkedopt12368-]=""><span class="questionlabel "><label for="optp38"><strong>MM+M News Brief</strong> -
delivers up-to-the-minute news alerts, stories and analysis to the healthcare marketing and communications sector, four days a week. News topics will span the full spectrum of MM+M's coverage.</label> </span>
<div id="longp38" class="longdescopt" style="display:none"></div>
</div>
<div id="pp40" class="drg-element-type-product drg-element-sub-type-type-2"><input name="opt12369" type="checkbox" value="1" id="optp40" [-checkedopt12369-]=""><span class="questionlabel "><label for="optp40"><strong>MM+M Weekly Digest</strong>
- a roundup of the week's big stories, people moves and notable developments in healthcare marketing, along with links to special reports and useful information from MM+M.</label> </span>
<div id="longp40" class="longdescopt" style="display:none"></div>
</div>
<div id="pp39" class="drg-element-type-product drg-element-sub-type-type-2"><input name="opt12370" type="checkbox" value="1" id="optp39" [-checkedopt12370-]=""><span class="questionlabel "><label for="optp39"><strong>The Splash from
MM+M</strong> - monthly email highlighting the latest, must-read feature articles from MM+M.</label> </span>
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-------------------------------------------------------------------------------- First Name Last Name Job Title Company Address 1 Address 2 City State/Province State/Province ALABAMAALASKAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFLORIDAGEORGIAHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTAOHIOOKLAHOMAOREGONPENNSYLVANIARHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMINGAmerican SamoaGuamMicronesia (Federated States of)Puerto RicoU.S. Minor Outlying IslandsNORTHERN MARIANA ISLANDSArmed Forces AfricaArmed Forces Americas AA (except Canada)Armed Forces CanadaArmed Forces Europe AEArmed Forces Middle East AEArmed Forces Pacific APALBERTANOVA SCOTIABRITISH COLUMBIAONTARIOMANITOBAPRINCE EDWARD ISLANDNEW BRUNSWICKQUEBECNEWFOUNDLANDSASKATCHEWANNORTHWEST TERRITORIESYUKON TERRITORYNUNAVUTFOREIGN Zip/Postal Code Country Country UNITED STATESCANADAAFGHANISTANALBANIAALGERIAANDORRAANGOLAANGUILLAANTARCTICAANTIGUAARGENTINAARMENIAARUBAASCENSION ISAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA-HERZEGOVINABOTSWANABRAZILBRITISH INDIAN OCEAN TERRITORYBRITISH VIRGIN ISBRUNEIBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCAPE VERDE ISLANDSCAYMAN ISLANDSCENTRAL AFRICAN REPCHADCHILECHINACOCO ISLANDCOLOMBIACOMOROSCONGOCOOK ISLANDSCOSTA RICACROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICEAST TIMORECUADOREGYPTEL SALVADORERITREAESTONIAETHIOPIAFAEROE ISLANDSFALKLAND ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUATEMALAGUERNSEYGUINEAGUYANAHAITIHONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELANDISLE OF MANISRAELITALYIVORY COASTJAMAICAJAPANJORDANKAZAKHSTANKENYAKIRIBATIKUWAITKYRGYZSTANLAOSLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIAMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIAMOLDOVAMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLAND ANTILLESNETHERLANDSNEW CALEDONIANEW GUINEANEW ZEALANDNICARAGUANIGERNIGERIANORTH KOREANORWAYOMANPAKISTANPALAUPALESTINEPANAMAPARAGUAYPERUPHILIPPINESPITCAIRN ISPOLANDPORTUGALQATARREUNIONROMANIARUSSIARWANDASAN MARINOSAO TOME E PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAK REPUBLICSLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH KOREASPAINSRI LANKAST CROIXST KITTSST LUCIAST MARTINST PIERREST VINCENTSUDANSURINAMESWAZILANDSWEDENSWITZERLANDSYRIATAIWANTAJIKISTANTANZANIATHAILANDTOGOTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS ISLANDTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMURUGUAYUZBEKISTANVANUATUVATICAN CITYVENEZUELAVIETNAMWALLIS ISLANDWESTERN SAHARAWESTERN SAMOAYEMENZAIREZAMBIAZIMBABWE Phone Email Confirm Email Address Please confirm which best describes the address type provided. Please confirm which best describes the address type provided. BusinessHomeOther (Please Specify) Other (Please Specify) -------------------------------------------------------------------------------- Please check the category that best describes your company: Please check the category that best describes your company: Healthcare Manufacturer - OtherHealthcare Manufacturer - PharmaceuticalHealthcare Manufacturer - Device/DiagnosticsHealthcare Manufacturer - BiotechAdvertising/Marketing/CommunicationsMedia CompanyCreative/Design FirmMarket Research FirmAccredited CME/EducationHealthcare Consulting Company (not incl. independent consultants)TechnologyPayor/PBM/InsurerHospital/Health System/Medical CareNon-Profit/Association/Government AgencyBusiness ServicesRetail/Wholesale/DistributorPrivate Equity/Investor/FinanceIndependent Consultant/FreelancerOther (Please Specify) Other (Please Specify) Which best describes your job function: Which best describes your job function: Corporate Management (C-level, President, etc.)Marketing/Advertising ExecutiveProduct/Brand/Therapeutic ExecutiveMediaCreative/DesignPublic Relations/CommunicationsSales ManagementMarket ResearchCMEManaged CareR&DRegulatory Affairs/Legal Affairs/ComplianceTechnologyFinanceOperationsConsultingEducator/Student/InternMedical DirectorMedical/Scientific AffairsOther (Please specify) Other (Please specify) Please select the option that best describes your title level: Please select the option that best describes your title level: C-LevelVP/SVP/EVPDirectorManagerNon-ManagerOther (Please specify) Other (Please specify) -------------------------------------------------------------------------------- Would you like to receive a FREE subscription to MM&M? Would you like to receive a FREE subscription to MM&M? YesNo -------------------------------------------------------------------------------- In addition to your subscription, MM+M offers email newsletters. Sign up for the newsletters below that are most relevant to you. (check all that apply) MM+M Breaking News - when big news hits, MM+M Breaking News alerts will deliver it straight to your inbox. MM+M News Brief - delivers up-to-the-minute news alerts, stories and analysis to the healthcare marketing and communications sector, four days a week. News topics will span the full spectrum of MM+M's coverage. MM+M Weekly Digest - a roundup of the week's big stories, people moves and notable developments in healthcare marketing, along with links to special reports and useful information from MM+M. The Splash from MM+M - monthly email highlighting the latest, must-read feature articles from MM+M. -------------------------------------------------------------------------------- Copyright © 2022 Haymarket Media, Inc. All Rights Reserved This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Your use of this website constitutes acceptance of Haymarket Media's Privacy Policy and Terms & Conditions. <%-- the gray background --%> Yes No