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		I wish to receive/continue to receive a FREE subscription to Higher Education Consortia magazine ___________________________________________________________________________________ I'm not a member of ACL, but would like to receive information about membership. ___________________________________________________________________________________ 3333333333'333Full Name 333333333333333Job Title 3333Institution/Organization 3sssssssssssssssss333Phone 333333333333331Address 333333333333333333City 33333333333333333'State 333333333333333333''Zip By providing your email address, you are giving your written permission to College Benefits Publishing, LLC to receive SUBSCRIPTION and other related information that may be of interest to you via email. We will not share/sell this information or use it for any other purpose. You may opt out any time in the future. 3333333333Email Address ___________________________________________________________________________________ Your Job Function (as close as possible) : Higher Education Consortium — President/Director/Senior Manager College/University — Chancellor/President/Provost/Dean College/University — Chief Financial Officer/Vice President of Finance/Financial Senior Manager College/University — Human Resources Director/Human Resources Senior Manager College/University — Benefits Director/Benefits Senior Manager College/University — Purchasing Director/Purchasing Senior Manager College/University — Senior Manager/Director/Department Head Association — Senior Manager/Executive Director Non-Profit — Senior Manager/Executive Director Foundation — Senior Manager/Executive Director Company Directly Serving Higher Education — Senior Manager ___________________________________________________________________________________ Number of Students: If you are a senior manager of a College/University, check total number of students. If you are a senior manager of a consortium, check total number of students from your member Colleges/Universities. 0-149 3 150-499 3 500-2,499 3 2,500- 4,999 3 5,000+ ___________________________________________________________________________________ Number of Employees: If you are a senior manager of a College/University, check total number of employees. If you are a senior manager of a consortium, check total number of employees from your member Colleges/Universities. 0-24 3 25-49 3 50-149 3 150-499 3 500-2,499 3 2,500-4,999 3 5000 + ___________________________________________________________________________________ Annual Budget for College/University: Only answer if you are a senior manager at a College/University. Consortium need not answer. $0-$499,000 3 $500,000-$999,000 3 $1,000,000-$9,999,000 3 $10,000,000 -$99,999,000 3 $100,000,000 + ___________________________________________________________________________________ Place of Birth This question acts as your electronic signature accepting this form as a formal subsciption to Higher Education Consortia magazine for a period of one year.