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<option Value="UNITED STATES">UNITED STATES</option>
<option Value="CANADA">CANADA</option>
<option Value="MEXICO">MEXICO</option>
<option Value="AFGHANISTAN">AFGHANISTAN</option>
<option Value="ALBANIA">ALBANIA</option>
<option Value="ALGERIA">ALGERIA</option>
<option Value="ANDORRA">ANDORRA</option>
<option Value="ANGOLA">ANGOLA</option>
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<option Value="ANTIGUA &amp; BARBUDA">ANTIGUA &amp; BARBUDA</option>
<option Value="ARGENTINA">ARGENTINA</option>
<option Value="ARMENIA">ARMENIA</option>
<option Value="ARUBA">ARUBA</option>
<option Value="ASCENSION ISLANDS">ASCENSION ISLANDS</option>
<option Value="AUSTRALIA">AUSTRALIA</option>
<option Value="AUSTRIA">AUSTRIA</option>
<option Value="AZERBAIJAN">AZERBAIJAN</option>
<option Value="BAHAMAS">BAHAMAS</option>
<option Value="BAHRAIN">BAHRAIN</option>
<option Value="BANGLADESH">BANGLADESH</option>
<option Value="BARBADOS">BARBADOS</option>
<option Value="BELARUS">BELARUS</option>
<option Value="BELGIUM">BELGIUM</option>
<option Value="BELIZE">BELIZE</option>
<option Value="BENIN">BENIN</option>
<option Value="BERMUDA">BERMUDA</option>
<option Value="BHUTAN">BHUTAN</option>
<option Value="BOLIVIA">BOLIVIA</option>
<option Value="BOSNIA-HERZEGOVINA">BOSNIA-HERZEGOVINA</option>
<option Value="BOTSWANA">BOTSWANA</option>
<option Value="BOUVET ISLAND">BOUVET ISLAND</option>
<option Value="BRAZIL">BRAZIL</option>
<option Value="BRUNEI">BRUNEI</option>
<option Value="BULGARIA">BULGARIA</option>
<option Value="BURKINA FASO">BURKINA FASO</option>
<option Value="BURMA">BURMA</option>
<option Value="BURUNDI">BURUNDI</option>
<option Value="CAMBODIA">CAMBODIA</option>
<option Value="CAMEROON">CAMEROON</option>
<option Value="CANARY ISLANDS">CANARY ISLANDS</option>
<option Value="CAPE VERDE">CAPE VERDE</option>
<option Value="CAYMAN ISLANDS">CAYMAN ISLANDS</option>
<option Value="CENTRAL AFRICAN REP">CENTRAL AFRICAN REP</option>
<option Value="CHAD">CHAD</option>
<option Value="CHANNEL ISLANDS">CHANNEL ISLANDS</option>
<option Value="CHILE">CHILE</option>
<option Value="CHINA">CHINA</option>
<option Value="COLOMBIA">COLOMBIA</option>
<option Value="COMOROS">COMOROS</option>
<option Value="CONGO">CONGO</option>
<option Value="COOK ISLANDS">COOK ISLANDS</option>
<option Value="COSTA RICA">COSTA RICA</option>
<option Value="COTE D'IVOIRE">COTE D'IVOIRE</option>
<option Value="CROATIA">CROATIA</option>
<option Value="CURACAO">CURACAO</option>
<option Value="CYPRUS">CYPRUS</option>
<option Value="CZECH REPUBLIC">CZECH REPUBLIC</option>
<option Value="DENMARK">DENMARK</option>
<option Value="DJIBOUTI">DJIBOUTI</option>
<option Value="DOMINICA">DOMINICA</option>
<option Value="DOMINICAN REPUBLIC">DOMINICAN REPUBLIC</option>
<option Value="EAST TIMOR">EAST TIMOR</option>
<option Value="ECUADOR">ECUADOR</option>
<option Value="EGYPT">EGYPT</option>
<option Value="EL SALVADOR">EL SALVADOR</option>
<option Value="EQUATORIAL GUINEA">EQUATORIAL GUINEA</option>
<option Value="ESTONIA">ESTONIA</option>
<option Value="ETHIOPIA">ETHIOPIA</option>
<option Value="FALKLAND ISLANDS">FALKLAND ISLANDS</option>
<option Value="FAROE ISLANDS">FAROE ISLANDS</option>
<option Value="FIJI">FIJI</option>
<option Value="FINLAND">FINLAND</option>
<option Value="FRANCE">FRANCE</option>
<option Value="FRENCH GUIANA">FRENCH GUIANA</option>
<option Value="GABON">GABON</option>
<option Value="GAMBIA">GAMBIA</option>
<option Value="GAZA STRIP">GAZA STRIP</option>
<option Value="GERMANY">GERMANY</option>
<option Value="GHANA">GHANA</option>
<option Value="GIBRALTAR">GIBRALTAR</option>
<option Value="GREECE">GREECE</option>
<option Value="GREENLAND">GREENLAND</option>
<option Value="GRENADA">GRENADA</option>
<option Value="GUADELOUPE">GUADELOUPE</option>
<option Value="GUATEMALA">GUATEMALA</option>
<option Value="GUINEA">GUINEA</option>
<option Value="GUINEA-BISSAU">GUINEA-BISSAU</option>
<option Value="GUYANA">GUYANA</option>
<option Value="HAITI">HAITI</option>
<option Value="HEARD ISLAND">HEARD ISLAND</option>
<option Value="HONDURAS">HONDURAS</option>
<option Value="HONG KONG">HONG KONG</option>
<option Value="HUNGARY">HUNGARY</option>
<option Value="ICELAND">ICELAND</option>
<option Value="INDIA">INDIA</option>
<option Value="INDONESIA">INDONESIA</option>
<option Value="IRELAND">IRELAND</option>
<option Value="ISLE OF MAN">ISLE OF MAN</option>
<option Value="ISRAEL">ISRAEL</option>
<option Value="ITALY">ITALY</option>
<option Value="JAMAICA">JAMAICA</option>
<option Value="JAN MAYEN &amp; SVALBARD">JAN MAYEN &amp; SVALBARD</option>
<option Value="JAPAN">JAPAN</option>
<option Value="JORDAN">JORDAN</option>
<option Value="KAZAKHSTAN">KAZAKHSTAN</option>
<option Value="KENYA">KENYA</option>
<option Value="KRYGYZSTAN">KRYGYZSTAN</option>
<option Value="KUWAIT">KUWAIT</option>
<option Value="LAOS">LAOS</option>
<option Value="LATVIA">LATVIA</option>
<option Value="LEBANON">LEBANON</option>
<option Value="LESOTHO">LESOTHO</option>
<option Value="LIBERIA">LIBERIA</option>
<option Value="LIECHTENSTEIN">LIECHTENSTEIN</option>
<option Value="LITHUANIA">LITHUANIA</option>
<option Value="LUXEMBOURG">LUXEMBOURG</option>
<option Value="MACEDONIA">MACEDONIA</option>
<option Value="MADAGASCAR">MADAGASCAR</option>
<option Value="MADEIRA ISLAND">MADEIRA ISLAND</option>
<option Value="MALAWI">MALAWI</option>
<option Value="MALAYSIA">MALAYSIA</option>
<option Value="MALDIVES">MALDIVES</option>
<option Value="MALI">MALI</option>
<option Value="MALTA">MALTA</option>
<option Value="MARTINIQUE">MARTINIQUE</option>
<option Value="MAURITANIA">MAURITANIA</option>
<option Value="MAURITIUS">MAURITIUS</option>
<option Value="MICRONESIA FED STATE">MICRONESIA FED STATE</option>
<option Value="MOLDOVA">MOLDOVA</option>
<option Value="MONACO">MONACO</option>
<option Value="MONGOLIA">MONGOLIA</option>
<option Value="MONTENEGRO">MONTENEGRO</option>
<option Value="MONTSERRAT">MONTSERRAT</option>
<option Value="MOROCCO">MOROCCO</option>
<option Value="MOZAMBIQUE">MOZAMBIQUE</option>
<option Value="MYANMAR">MYANMAR</option>
<option Value="NAMIBIA">NAMIBIA</option>
<option Value="NAURU">NAURU</option>
<option Value="NEPAL">NEPAL</option>
<option Value="NETHERLANDS">NETHERLANDS</option>
<option Value="NEW CALEDONIA">NEW CALEDONIA</option>
<option Value="NEW ZEALAND">NEW ZEALAND</option>
<option Value="NICARAGUA">NICARAGUA</option>
<option Value="NIGER">NIGER</option>
<option Value="NIGERIA">NIGERIA</option>
<option Value="NIUE">NIUE</option>
<option Value="NORWAY">NORWAY</option>
<option Value="OMAN">OMAN</option>
<option Value="PAKISTAN">PAKISTAN</option>
<option Value="PANAMA">PANAMA</option>
<option Value="PAPUA NEW GUINEA">PAPUA NEW GUINEA</option>
<option Value="PARAGUAY">PARAGUAY</option>
<option Value="PEOPLES REPUBLIC OF CHINA">PEOPLES REPUBLIC OF CHINA</option>
<option Value="PERU">PERU</option>
<option Value="PHILIPPINES">PHILIPPINES</option>
<option Value="PITCAIRN ISLAND">PITCAIRN ISLAND</option>
<option Value="POLAND">POLAND</option>
<option Value="PORTUGAL">PORTUGAL</option>
<option Value="QATAR">QATAR</option>
<option Value="REPUBLIC OF GEORGIA">REPUBLIC OF GEORGIA</option>
<option Value="REUNION ISLAND">REUNION ISLAND</option>
<option Value="ROMANIA">ROMANIA</option>
<option Value="RUSSIA">RUSSIA</option>
<option Value="RWANDA">RWANDA</option>
<option Value="SAINT PIERRE">SAINT PIERRE</option>
<option Value="SAN MARINO">SAN MARINO</option>
<option Value="SAO TOME PRINCIPE">SAO TOME PRINCIPE</option>
<option Value="SAUDI ARABIA">SAUDI ARABIA</option>
<option Value="SENEGAL">SENEGAL</option>
<option Value="SERBIA">SERBIA</option>
<option Value="SEYCHELLES">SEYCHELLES</option>
<option Value="SIERRA LEONE">SIERRA LEONE</option>
<option Value="SINGAPORE">SINGAPORE</option>
<option Value="SLOVAKIA">SLOVAKIA</option>
<option Value="SLOVENIA">SLOVENIA</option>
<option Value="SOLOMON ISLANDS">SOLOMON ISLANDS</option>
<option Value="SOMALIA">SOMALIA</option>
<option Value="SOUTH AFRICA">SOUTH AFRICA</option>
<option Value="SOUTH KOREA">SOUTH KOREA</option>
<option Value="SPAIN">SPAIN</option>
<option Value="SRI LANKA">SRI LANKA</option>
<option Value="ST BARTHELEMY">ST BARTHELEMY</option>
<option Value="ST KITTS &amp; NEVIS">ST KITTS &amp; NEVIS</option>
<option Value="SURINAME">SURINAME</option>
<option Value="SWAN ISLAND">SWAN ISLAND</option>
<option Value="SWAZILAND">SWAZILAND</option>
<option Value="SWEDEN">SWEDEN</option>
<option Value="SWITZERLAND">SWITZERLAND</option>
<option Value="TAHITI">TAHITI</option>
<option Value="TAIWAN">TAIWAN</option>
<option Value="TAJIKISTAN">TAJIKISTAN</option>
<option Value="TANZANIA">TANZANIA</option>
<option Value="THAILAND">THAILAND</option>
<option Value="TOGO">TOGO</option>
<option Value="TOKELAU">TOKELAU</option>
<option Value="TONGA">TONGA</option>
<option Value="TRINIDAD &amp; TOBAGO">TRINIDAD &amp; TOBAGO</option>
<option Value="TRISTAN DA CUNHA">TRISTAN DA CUNHA</option>
<option Value="TUNISIA">TUNISIA</option>
<option Value="TURKEY">TURKEY</option>
<option Value="TURKMENISTAN">TURKMENISTAN</option>
<option Value="TURKS &amp; CAICOS ISLAND">TURKS &amp; CAICOS ISLAND</option>
<option Value="UGANDA">UGANDA</option>
<option Value="UKRAINE">UKRAINE</option>
<option Value="UNITED ARAB EMIRATES">UNITED ARAB EMIRATES</option>
<option Value="UNITED KINGDOM">UNITED KINGDOM</option>
<option Value="UPPER VOLTA">UPPER VOLTA</option>
<option Value="URUGUAY">URUGUAY</option>
<option Value="UZBEKISTAN">UZBEKISTAN</option>
<option Value="VANUATU">VANUATU</option>
<option Value="VATICAN CITY">VATICAN CITY</option>
<option Value="VENEZUELA">VENEZUELA</option>
<option Value="VIETNAM">VIETNAM</option>
<option Value="VIRGIN ISLANDS">VIRGIN ISLANDS</option>
<option Value="WALLIS FUTUNA">WALLIS FUTUNA</option>
<option Value="WESTERN SAHARA">WESTERN SAHARA</option>
<option Value="WESTERN SAMOA">WESTERN SAMOA</option>
<option Value="YEMEN">YEMEN</option>
<option Value="ZAMBIA">ZAMBIA</option>
<option Value="ZIMBABWE">ZIMBABWE</option>
<option Value="OTHER, NOT LISTED">OTHER, NOT LISTED</option></select>
	                        <font color="#CC0000"> *</font> </td>
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<div id="main_div"><span class="headliner_b_size">About You and Your Company</span><br>
    
<input type="hidden" name="RequiredQuestion" value="What is the primary end product manufactured or service performed at your location?">
    
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<td valign="top" colspan="2"><span class="headliner_c_size"><b>What is the primary end product manufactured or service performed at your location?</b></span></td>
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<td colspan="2">
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<td valign="top" colspan="2"><b>Manufacturing</b></td>
</tr>
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<td valign="top"><input type="radio" name="5914" value="1" id="1"></td>
<td valign="center"><label for="1">Food and beverage</label></td>
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<td valign="top"><input type="radio" name="5914" value="2" id="2"></td>
<td valign="center"><label for="2">Industrial, commercial, agricultural, and other machinery</label></td>
</tr>
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<td valign="top"><input type="radio" name="5914" value="3" id="3"></td>
<td valign="center"><label for="3">Textile mill</label></td>
</tr>
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<td valign="top"><input type="radio" name="5914" value="4" id="4"></td>
<td valign="center"><label for="4">Pulp and paper</label></td>
</tr>
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<td valign="top"><input type="radio" name="5914" value="5" id="5"></td>
<td valign="center"><label for="5">Petroleum, refining</label></td>
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<td valign="top"><input type="radio" name="5914" value="6" id="6"></td>
<td valign="center"><label for="6">Chemical</label></td>
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<td valign="top"><input type="radio" name="5914" value="7" id="7"></td>
<td valign="center"><label for="7">Pharmaceutical</label></td>
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<td valign="top"><input type="radio" name="5914" value="8" id="8"></td>
<td valign="center"><label for="8">Plastics and rubber</label></td>
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<td valign="top"><input type="radio" name="5914" value="9" id="9"></td>
<td valign="center"><label for="9">Primary metals</label></td>
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<td valign="top"><input type="radio" name="5914" value="10" id="10"></td>
<td valign="center"><label for="10">Fabricated metals</label></td>
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<td valign="top"><input type="radio" name="5914" value="11" id="11"></td>
<td valign="center"><label for="11">Engine, turbine, mechanical, and electrical power transmission equipment</label></td>
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<td valign="top"><input type="radio" name="5914" value="12" id="12"></td>
<td valign="center"><label for="12">Computers and communication equipment</label></td>
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<td valign="top"><input type="radio" name="5914" value="13" id="13"></td>
<td valign="center"><label for="13">Electronic components</label></td>
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<td valign="top"><input type="radio" name="5914" value="14" id="14"></td>
<td valign="center"><label for="14">Instrumentation, measurement, and control systems and devices</label></td>
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<td valign="top"><input type="radio" name="5914" value="15" id="15"></td>
<td valign="center"><label for="15">Other electronic products and equipment</label></td>
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<td valign="top"><input type="radio" name="5914" value="16" id="16"></td>
<td valign="center"><label for="16">Medical equipment and instruments</label></td>
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<td valign="top"><input type="radio" name="5914" value="17" id="17"></td>
<td valign="center"><label for="17">Motor vehicles and components</label></td>
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<td valign="top"><input type="radio" name="5914" value="18" id="18"></td>
<td valign="center"><label for="18">Aircraft and aerospace</label></td>
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<td valign="top"><input type="radio" name="5914" value="19" id="19"></td>
<td valign="center"><label for="19">Other transportation equipment</label></td>
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<td valign="top"><input type="radio" name="5914" value="20" id="20"></td>
<td valign="center"><label for="20">Other manufacturing and processes (please describe)<br><input type="text" name="21/"></label></td>
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<td valign="top" colspan="2"><br><b>Non-Manufacturing</b></td>
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<td valign="top"><input type="radio" name="5914" value="22" id="22"></td>
<td valign="center"><label for="22">Mining</label></td>
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<td valign="top"><input type="radio" name="5914" value="23" id="23"></td>
<td valign="center"><label for="23">Utilities</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5914" value="24" id="24"></td>
<td valign="center"><label for="24">Engineering, system integration, and architectural services</label></td>
</tr>
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<td valign="top"><input type="radio" name="5914" value="25" id="25"></td>
<td valign="center"><label for="25">Scientific and research services</label></td>
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<td valign="top"><input type="radio" name="5914" value="26" id="26"></td>
<td valign="center"><label for="26">Information, data processing, and software services</label></td>
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<td valign="top"><input type="radio" name="5914" value="27" id="27"></td>
<td valign="center"><label for="27">Government and military</label></td>
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<td valign="top"><input type="radio" name="5914" value="28" id="28"></td>
<td valign="center"><label for="28">Other non-manufacturing</label></td>
</tr>
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<td valign="top"><input type="radio" name="5914" value="29" id="29"></td>
<td valign="center"><label for="29">Other (please describe)<br><input type="text" name="30/"></label></td>
</tr>
</tbody>
</table>
</td>
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</tbody>
</table><br><hr color="#000000" size="1">
<table cellspacing="0" cellpadding="0" border="0">
<tbody>
<tr>
<td valign="top" colspan="2"><span class="headliner_c_size"><b>What is your primary job function?</b></span></td>
</tr>
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<td colspan="2">
</td>
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</tbody>
</table>
<table cellspacing="0" cellpadding="5" border="0">
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<td valign="top" width="">
<table cellspacing="0" cellpadding="0" border="0">
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<td valign="top"><input type="radio" name="5915" value="40" id="40"></td>
<td valign="center"><label for="40">Process Engineering</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="41" id="41"></td>
<td valign="center"><label for="41">Control/Instrument Engineering</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="42" id="42"></td>
<td valign="center"><label for="42">System Design Engineering including Applied R&D</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="43" id="43"></td>
<td valign="center"><label for="43">Product Design Engineering including Applied R&D</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="44" id="44"></td>
<td valign="center"><label for="44">Production/Manufacturing Engineering</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="45" id="45"></td>
<td valign="center"><label for="45">System Integration/Consulting</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="46" id="46"></td>
<td valign="center"><label for="46">Evaluation, Quality Control, Standards, Reliability, and/or Test Engineering</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="47" id="47"></td>
<td valign="center"><label for="47">Other Engineering, including Project, Software, Plant, Electrical, and/or Electronic</label></td>
</tr>
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<td valign="top"><input type="radio" name="5915" value="48" id="48"></td>
<td valign="center"><label for="48">General or Corporate Management</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="49" id="49"></td>
<td valign="center"><label for="49">Operations and Maintenance</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5915" value="50" id="50"></td>
<td valign="center"><label for="50">Other (please describe)<br><input type="text" name="51/"></label></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table><br><hr color="#000000" size="1">
<table cellspacing="0" cellpadding="0" border="0">
<tbody>
<tr>
<td valign="top" colspan="2"><span class="headliner_c_size"><b>Which of the following products and systems do you recommend, specify, and/or buy? (Check ALL that apply)</b></span></td>
</tr>
<tr>
<td colspan="2">
</td>
</tr>
</tbody>
</table>
<table cellspacing="0" cellpadding="5" border="0">
<tbody>
<tr>
<td valign="top">
<table cellspacing="0" cellpadding="0" border="0">
<tbody>
<tr>
<td valign="top" colspan="2"><b>Information Control</b></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="60" value="60" id="60"></td>
<td valign="center"><label for="60">Data Acquisition Equipment, Recorders and Plotters</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="61" value="61" id="61"></td>
<td valign="center"><label for="61">Controllers and Regulators</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="62" value="62" id="62"></td>
<td valign="center"><label for="62">Programmable Logic Controllers (PLC)</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="63" value="63" id="63"></td>
<td valign="center"><label for="63">Human Machine Interface Equipment</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="64" value="64" id="64"></td>
<td valign="center"><label for="64">Control Systems (DCS and PC-based)</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="65" value="65" id="65"></td>
<td valign="center"><label for="65">Computers</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="66" value="66" id="66"></td>
<td valign="center"><label for="66">Embedded Systems</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="67" value="67" id="67"></td>
<td valign="center"><label for="67">HMI/SCADA Software</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="68" value="68" id="68"></td>
<td valign="center"><label for="68">MES/Batch/Historian Software</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="69" value="69" id="69"></td>
<td valign="center"><label for="69">Design and Other Software</label></td>
</tr>
<tr>
<td valign="top" colspan="2"><br><b>Process Control</b></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="70" value="70" id="70"></td>
<td valign="center"><label for="70">Analytical Instruments, Test and Calibration Equipment</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="71" value="71" id="71"></td>
<td valign="center"><label for="71">Process Sensors and Transmitters (includes flow, pressure, temperature and level)</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="72" value="72" id="72"></td>
<td valign="center"><label for="72">Valves, Actuators, and Positioners</label></td>
</tr>
<tr>
<td valign="top" colspan="2"><br><b>Discrete Control</b></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="73" value="73" id="73"></td>
<td valign="center"><label for="73">Discrete Sensors (includes proximity, photoelectric)</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="74" value="74" id="74"></td>
<td valign="center"><label for="74">Vision Systems</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="75" value="75" id="75"></td>
<td valign="center"><label for="75">Motion Control Systems</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="76" value="76" id="76"></td>
<td valign="center"><label for="76">Motors and Drives (includes starters and protection devices)</label></td>
</tr>
<tr>
<td valign="top" colspan="2"><br><b>System Integration</b></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="77" value="77" id="77"></td>
<td valign="center"><label for="77">Control Panels, Alarms, and Annunciators</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="78" value="78" id="78"></td>
<td valign="center"><label for="78">I/O Products and Systems</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="79" value="79" id="79"></td>
<td valign="center"><label for="79">Enclosures</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="80" value="80" id="80"></td>
<td valign="center"><label for="80">Networking, Connectors, Wire, and Cable</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="81" value="81" id="81"></td>
<td valign="center"><label for="81">Relays, Switches, and Timers</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="82" value="82" id="82"></td>
<td valign="center"><label for="82">Power Systems and Supplies</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="83" value="83" id="83"></td>
<td valign="center"><label for="83">Safety for Process and Machine Systems</label></td>
</tr>
<tr>
<td valign="top"><input type="checkbox" name="84" value="84" id="84"></td>
<td valign="center"><label for="84">Wireless, RFID</label></td>
</tr>
<tr>
<td valign="top" colspan="2"><br><b> </b></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td valign="center" colspan="10" height="10"></td>
</tr>
<tr>
<td colspan="10" align="center" valign="center"><input type="checkbox" name="86" value="86">None of the Above</td>
</tr>
</tbody>
</table><br><hr color="#000000" size="1">
<table cellspacing="0" cellpadding="0" border="0">
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<td valign="top" colspan="2"><span class="headliner_c_size"><b>Are you involved in system integration?</b></span></td>
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<td colspan="2">
</td>
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</tbody>
</table>
<table cellspacing="0" cellpadding="5" border="0">
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<td valign="top" width="">
<table cellspacing="0" cellpadding="0" border="0">
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<td valign="top"><input type="radio" name="5917" value="90" id="90"></td>
<td valign="center"><label for="90">Yes</label></td>
</tr>
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<td valign="top"><input type="radio" name="5917" value="91" id="91"></td>
<td valign="center"><label for="91">No</label></td>
</tr>
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</table>
</td>
</tr>
</tbody>
</table><br><hr color="#000000" size="1">
<table cellspacing="0" cellpadding="0" border="0">
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<td valign="top" colspan="2"><span class="headliner_c_size"><b>What is the approximate number of employees at your location?</b></span></td>
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<td colspan="2">
</td>
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</tbody>
</table>
<table cellspacing="0" cellpadding="5" border="0">
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<td valign="top" width="">
<table cellspacing="0" cellpadding="0" border="0">
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<td valign="top"><input type="radio" name="5916" value="100" id="100"></td>
<td valign="center"><label for="100">1,000 or more</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5916" value="101" id="101"></td>
<td valign="center"><label for="101">500-999</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5916" value="102" id="102"></td>
<td valign="center"><label for="102">250-499</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5916" value="103" id="103"></td>
<td valign="center"><label for="103">100-249</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5916" value="104" id="104"></td>
<td valign="center"><label for="104">Less than 100</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table><br><hr color="#000000" size="1">
<table cellspacing="0" cellpadding="0" border="0">
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<td valign="top" colspan="2"><span class="headliner_c_size"><b>BONUS OFFER- Which of the following FREE e-mail newsletters would you like to receive?</b></span></td>
</tr>
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<td colspan="2">
</td>
</tr>
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</table>
<table cellspacing="0" cellpadding="5" border="0">
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<td valign="top" width="">
<table cellspacing="0" cellpadding="0" border="0">
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<td valign="top"><input type="checkbox" name="120" id="120" value="120"></td>
<td valign="center"><label for="120">IAN Inside Products News E-newsletter</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table><br><hr color="#000000" size="1">
<table cellspacing="0" cellpadding="0" border="0">
<tbody>
<tr>
<td valign="top" colspan="2"><span class="headliner_c_size"><b>IAN Inside Products and Harris Poll have partnered to create an online research panel enabling you to shape the future of your industry, while compensating you for your feedback.

Would you like to join this expert online research panel?

(If you answer "Yes" you will receive an email in the next few weeks explaining how this panel will work.)</b></span></td>
</tr>
<tr>
<td colspan="2">
</td>
</tr>
</tbody>
</table>
<table cellspacing="0" cellpadding="5" border="0">
<tbody>
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<td valign="top" width="">
<table cellspacing="0" cellpadding="0" border="0">
<tbody>
<tr>
<td valign="top"><input type="radio" name="5920" value="125" id="125"></td>
<td valign="center"><label for="125">Yes</label></td>
</tr>
<tr>
<td valign="top"><input type="radio" name="5920" value="126" id="126"></td>
<td valign="center"><label for="126">No</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table><br><hr color="#000000" size="1">
</div>
</td>
</tr>
		
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