Tablets & Capsules

TC0118

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First Name Last Name Job Title Company Business Address City State Postal Code Country Business Phone Business Fax E-mail Signature Date / / New Subscriber — if you qualify Tablets & Capsules will be sent to you without cost or obligation. Unless all information is given, magazine cannot be sent. Principal job function (check only one): 1. n Process/Production Engineering 2. n Validation 3. n R&D 4. n QC/QA 5. n Plant Management 6. n Operations Management 7. n Corporate Management 8. n Consulting Engineering 9. n Packaging Management Number of Employees at this location: 10. n 1,000 or more 11. n 500-999 12. n 100-499 13. n 50-99 14. n 20-49 15. n Under 20 What is your company's primary business? (check only one): This form is also available online at: www.tabletscapsules.com Pass it along! Give your colleagues their own FREE subscription to Tablets & Capsules. 21 n PHARMACEUTICAL MFG 22 n NUTRACEUTICAL MFG 23 n VITAMIN MFG 24 n FOOD MFG 25 n CHEMICAL MFG 26 n CONTRACT MFG/PACKAGING 27 n CONSULTING ENGINEERING 28 n EDUCATION INSTITUTIONS 29 n EQUIPMENT MFG 30 n PHARMACEUTICAL MATERIALS 31 n MANUFACTURER'S REPS 32 n CONSULTANT 33 n PACKAGING MATERIALS 34 n R&D LABS 35 n GOVERNMENT 36 n OTHER ________________________ TC PB JF PS Do you wish to receive Tablets & Capsules magazine? n Yes n No How would you like to receive Tablets & Capsules magazine? n Print n Digital Do you currently manufacture tablets at this location? n Yes n No Do you currently manufacture capsules at this location? n Yes n No We reserve the right to use contact information provided here to manage your free subscription.

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