Editorial Quality Audit / Participation form

11/11/2002


Please print out this form, complete it, and FAX it to 847-390-2656.

Yes, I would like to help evaluate the articles in PLANT ENGINEERING magazine by participating in the Editorial Quality Audit on a regular basis.

Name: __________________________________________________

Job Title: ________________________________________________

Company: _______________________________________________

Division: _________________________________________________

Mail address: _____________________________________________

City: ___________________________________________

State: _________ Zip: _____________

Phone: _________________________________________

Fax: ___________________________

If you would like EQA materials mailed to your home, please provide the following:

Home street address: _______________________________________

City: ___________________________________________

State: _________ Zip: _____________

** Subscriber # or issue label (required): _____________________

Background Information

Type of business (check only one):

( ) Food & kindred products
( ) Leather, leather products
( ) Tobacco
( ) Stone, clay, glass products
( ) Textile mill products
( ) Primary metals
( ) Apparel, other textile products
( ) Fabricated metal products
( ) Lumber & wood products
( ) Machinery, except electrical
( ) Furniture & fixtures
( ) Electric & electronic equipment
( ) Paper & allied products
( ) Transportation equipment
( ) Printing & publishing
( ) Instruments & related products
( ) Chemicals & allied products
( ) Miscellaneous manufacturing
( ) Petroleum & coal products
( ) Nonmanufacturing
( ) Rubber, plastic products

Primary job responsibility (check only one):

( ) Manage all plant engineering and maintenance

( ) Manage plant engineering only (excluding maintenance)

( ) Manage maintenance only

( ) Supervise group within plant engineering and/or maintenance

Please define:_________________________________________________

( ) Provide staff services for plant engineering and/or maintenance

( ) Provide consulting services to plant engineering and/or maintenance

( ) Provide other services in addition to plant engineering and/or maintenance

( ) Other job function:

Please define:

Approximate number of employees at this plant (check one):

( ) 1-19
( ) 50-99
( ) 250-499
( ) 1000 or more
( ) 20-49
( ) 100-249
( ) 500-999

Number of full-time employees in plant engineering and maintenace at this
plant (circle one):

( ) 1-9
( ) 25-49
( ) 100-199
( ) 10-24
( ) 50-99
( ) 200 or more

Participation Agreement

As a participant in the PLANT ENGINEERING Editorial Quality Audit, I understand that my opinions are important to the editors of PLANT ENGINEERING magazine. I will therefore make a concerted effort to evaluate articles as requested in a timely manner.

Signature:________________________

Date:____________________________

Please print out this form, complete it, and FAX it to 630-320-7145.





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