Verified Associate Member Qualification Form
Associate Membership allows qualified media buyers, advertisers and advertising agencies instant online access to Verified's Audit Reports, Publisher's Statements and circulation data downloads at no cost. There is no charge for Associate Membership, but you must qualify by filling out this form and returning submitting it to us.

Verified does not use, sell, rent, share or otherwise disclose Associate Member information to any third party.

Please provide the following information and submit the completed form to us.

All submissions will be validated by a confirmation email reply and Verified may contact applicants to confirm submitted information.

Verified reserves the right to restrict Associate Membership to individuals and organizations meeting our qualification standards and to terminate Associate Membership at its sole discretion without notice.

Name
Title
Company/Association
Address
Address
City
State
Zip
Phone
Fax
Email
Web Address

Please let us know a little about you by responding to the questions below:

Which of the following best describes your company? (select one)



Which of the following best describes your job function? (select one)



Other

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to subscribe, please check the box below. You can unsubscribe at any time.

Yes, I would like to subscribe to ViewPoint.

I state that the information provided above is true and accurate, and I agree to
abide by Verified s terms of Associate Membership.