• FREE SUBSCRIPTION includes twelve (12) issues per year for qualified applicants. All subscriptions are at the discretion of the publisher. Note: US & International Subscriptions are $40US per year. We will invoice you.
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  • Contact Details
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  • First Name*
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  • Last Name*
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  • Title*
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  • Company*
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  • Address 1*Street Address
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  • Address 2*Apt, Unit, Suite, etc.
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  • City*
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  • Postal or Zip*
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  • Country*
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  • Province or State*
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  • Phone*
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  • Fax*
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  • Email Address*
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  • Mother's Maiden Name*
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  • Business Details
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  • Your organization's annual sales volume in $Millions*
    0
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  • Our company markets in*check all that apply
    Canada
    United States
    Internationally
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  • I am involved with*check all that apply
    Consumer Direct Marketing
    B 2 B Direct Marketing
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  • Business Type
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  • Non DM Industry Suppliers*Select if Applies
    Association, membership organization, club
    High Tech Equipment and/or Software
    Catalogue and/or Retail, Continuity Club, Mail Order
    Other Manufacturer/Industrial/Distributor
    Educational (seminars, schools, universities)
    Package Goods and Mass Consumer Services
    Financial Services (banks, insurance, credit, investment)
    Publisher/Subscription
    Government, Economic Development, other public service
    Tourism & Travel
    Major Services (utilities, heath care, transportation, etc)
    Entertainment
    Fund Raiser, Non-Profit, Charity, Cultural Group, etc.
    Other
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  • Direct Response Agency | Consultant | Creative | Design*Select if Applies
    General Advertising Agency
    Freelance | Creative | Copy | Strategy
    Direct Marketing Division or Subsidiary
    Independent Direct Marketing Consultant
    Independent Direct Marketing Agency
    Other
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  • Direct Marketing Media*Select if Applies
    Print Media (magazine, newspaper, coop mailer, coupon, flyers)
    Solo Web Site
    Electronic Media (TV, Cable, Interactive, Radio)
    Email/Online Media Channel
    Mailing List Professional (Broker, Manager, Compiler, Owner)
    CD ROM/DVD Manufacturer
    Call Centre (Outbound and/or Inbound)
    Other
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  • Direct Marketing Services*Select if Applies
    Envelopes and/or Dimensional Format Mailers
    Market Research and/or Customer
    Service/Satisfaction Survey & Measurement
    Full Service Mailing Operations
    Staffing & Recruitment
    Association or Industry Organization
    Training & Education
    Database Marketing Agency and/or Consultant
    Consumer Surveys/Interviews/Telephone
    Polls/Online Polls
    Fund Raising and/or Non-Profit Agency or Consultant
    Other
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  • Tools, Technologies & Systems*Select if Applies
    Computer Service Bureau/Data
    Processing/Data Entry Data Warehouse/Data Mart Systems
    CRM and/or eCRM Vendor, Reseller/VAR, Consultant
    Call Centre Software/Hardware/Technology
    Database Marketing Systems & Services
    Call Centre Staffing/Training/Scripting
    DataMining/Targeting/Analytical Tools
    Other
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  • Print, Production & Logistics*Select if Applies
    Distribution/Delivery Services
    Variable Imaging
    Lettershop and/or Fulfillment House
    On Demand Printing
    Mail Preparation & Processing
    Electronic Document Creation, Processing,
    Fulfillment
    Payment Processing/Collections
    Printing and/or Production
    Other
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  • Lists and Data*Select if Applies
    Enhancing and/or Appending Sources
    List Broker Only
    Alternative Direct Response Media
    List Compiler
    Full Services List Company
    List Manager Only
    Other:
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  • Job Function
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  • Please indicate one primary job function and as many secondary job functions as apply:*PrimarySecondaryNot Applicable
    Corporate General Management
    Direct Marketing/Response Marketing
    Market Research/Market Analyst/Marketing Analyst
    Advertising/Customer Acquisition
    Loyalty/Relationship/Customer Retention
    Production and/or Creative
    Promotion/Merchandising/Brand Development
    Sales/Telemarketing/Account Management
    Customer Service/Consumer Affairs/Customer Support/Privacy
    Mail Preparation/Operations/Fulfillment
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  • I Approve
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  • I specify, recommend, approve, purchase or influence the purchase of:*Check all that apply
    Mailing Lists
    Direct Marketing Media
    Telemarketing and/or Call Centre Services
    Association Membership
    Printing/Variable Imaging/Customized Communications
    Staffing, Training & Education
    Market Research
    Web Site Marketing
    Mailing Services CRM/Database Marketing/Loyalty related software and/or services
    Distribution Services
    Creative/Design Services
    Other
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  • Please send more Info*Regarding
    Advertising in Direct Marketing
    Renting the Direct Marketing mailing list
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  • I undertand*I undertand that I must renew my subscription from time to time (at no charge) and I can withdraw my consent to unsubscribe from the mailing list at any time
    Yes, I want a FREE subscription to Direct Marketing (12 issues per year) and signup to receive emails .
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  • FOR U.S. or INTERNATIONAL SUBSCRIBERS ONLY
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  • Subscriptions for US residents are $60.00US per year. (If you are non-Canadian based and you complete this form without this section, you will not receive any issues.)
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  • Payments Details*
    Bill Me
    I'm mailing a cheque
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  • Purchase Order #*
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  • Make cheque out to Lloydmedia, Inc. and mail to: 302-137 Main Street North Markham, ON L3P 1Y2
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