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QUALIFICATION FORM

Incomplete forms will not be processed. A complimentary subscription to National Driller will be sent to those applicants who qualify. The publisher reserves the right to limit the number of subscriptions accepted.

1.	I wish to receive National Driller magazine FREE of charge.

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NOTE: In order to be considered for a subscription to National Driller, you MUST select Yes above. If you do not select Yes, you will not receive a complimentary subscription to National Driller.

2.	Please check the preferred format:

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*All digital subscribers will receive the print version until digital is available.

3.	What is your company's primary business? (select ONE only)

Drilling Contractor

Pump Installation Contractor

Irrigation Contractor

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Engineering

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4.	What is your job title? (select ONE only)

Owner/Executive

Driller/Drilling Supervisor

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5.	What type(s) of work does your company perform? (select ALL that apply)

6.	How many employees are in your company? (select ONE only)

7.	Do you specify, design, recommend and/or purchase drilling equipment, supplies and/or services for your company?

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8.	Which of the following trade magazine(s) do you receive? (select ALL that apply)

Water Well Journal

WorldWide Drilling Resources

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