*First Name |
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*Last Name |
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Title |
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*Company |
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*Address 1 |
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Address 2 |
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*City |
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*State / Province |
(for U.S./Canada)
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Province |
(for other international countries) |
*Zip / Postal code |
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*Country |
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Phone |
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Fax |
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*E-mail |
How we use your information
By supplying your email address, fax and phone numbers, you authorize Vitamin Retailer Magazine, Inc. to use them to contact you about your subscription or other Vitamin Retailer Magazine, Inc. products or events. We value your privacy and will not rent or sell your information.
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*What is your primary business type (select one)?
A. Natural/Health/Organic Food Store
B. Supermarket
C. Drug Store/Pharmacy
D. Natural/Nutritional Product Broker
E. Wholesaler/Distributor
F. Manufacturer/Supplier
G. Professional Health Care
H. VItamin/Nutritional Supplement Store
Z. Other
If other, please specify
*What is your primary job title (select one)?
A. Owner, President, Chairperson, CEO, Partner
B. VP, COO, CFO, GM
C. Division/Regional/Store Director or Manager
E. Health Care Practitioner
F. Marketing/Sales Director or Manager
G. Buyer
H. Researcher/Product Developer
J. Nutritionist/Dietician/Wellness or Health Consultant
K. Retail Sales Associate
L. Package Designer
Z. Other
If other, please specify
What type(s) of products are sold at your facility (select all that apply)?
A. Vitamins
B. Supplements
C. Minerals
D. Herbs/Homeopathics
E. Sports Nutritional Products
F. Functional/Fortified Foods
G. Functional/Fortified Beverages
H. Vitamins/Supplements for Pets
Z. None Of the Above
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*What is the last digit of your year of birth?

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