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Submitted URL: https://lnktrk.canadiangrocer.com/ODI1LUxTUC01NDUAAAGOdZD4-so2EHt8pRbjuwJZAyu7Xl13LPL1JAnAsDY9-r3aNzbQfM8jZidN1-4YoGUXpyB4TuY=
Effective URL: https://eiq.dragonforms.com/loading.do?pk=NLINITIAL&omedasite=CG_QUAL&mkt_tok=ODI1LUxTUC01NDUAAAGOdZD4-oSmqVRqmMIjKx87x119Lq...
Submission: On September 27 via api from US — Scanned from DE
Effective URL: https://eiq.dragonforms.com/loading.do?pk=NLINITIAL&omedasite=CG_QUAL&mkt_tok=ODI1LUxTUC01NDUAAAGOdZD4-oSmqVRqmMIjKx87x119Lq...
Submission: On September 27 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST saveNewSubscription.do;jsessionid=32157865BC4803213A16CF8160270ACC;jsessionid=32157865BC4803213A16CF8160270ACC
<form method="post" accept-charset="utf-8" action="saveNewSubscription.do;jsessionid=32157865BC4803213A16CF8160270ACC;jsessionid=32157865BC4803213A16CF8160270ACC" id="standardForm"><input type="hidden" name="14" id="14" value="1"><input type="hidden"
id="dragonjsessionid" name="dragonjsessionid" value="32157865BC4803213A16CF8160270ACC"><input type="hidden" id="omedasite" name="omedasite" value="CG_QUAL"><input type="hidden" id="shippingaddresscountry" name="shippingaddresscountry" value="7">
<nav class="drgNav nav" style="display: none;"><select>
<option selected="selected" value="">Go to...</option>
</select></nav>
<div class="container contentbg bordertop borderleft borderright borderbottom">
<header class="row borderbottom headercontainer">
<div class="twelvecol">
<span class="logo"><img src="https://hostedcontent.dragonforms.com/hosted/images/dragon/12391/184.png" alt="CG Logo 400 px"></span>
<span class="cover"></span>
</div>
</header>
<header class="row">
<div class="twelvecol">
<span class="content0"><input name="demo319123" type="hidden" value="NLINITIAL" id="demo319123"></span>
</div>
</header>
<section class="row">
<div class="twelvecol">
<section class="content1">
<h2 style="">New Subscription</h2>
<ul class="breadcrumb">
<li class="zoetic">
<div class="crumbitem current">Your Information</div>
</li>
<li class="">
<div class="crumbitem">Your Profile</div>
</li>
<li class="">
<div class="crumbitem">Confirmation</div>
</li>
</ul>
<span style="color: rgb(85, 85, 85); font-family: Arial; font-size: 14px; ">Fields with an <font color="#ff0000">*</font> are required.</span>
</section>
</div>
</section>
<section class="row">
<div class="twelvecol">
<section class="validation">
<ul></ul>
</section>
</div>
</section>
<section class="row">
<div class="sixcol">
<section class="content2">
<p id="p13" class="drg-element-type-standard-field drg-element-sub-type-fieldname-EMAILADDR addresslabel"><span class="questionlabel "><label for="id13">Email Address <font color="red">*</font></label> </span><input
class="drg-field-address-normal" name="demo319127" type="text" value="" id="id13" maxlength="50" size="50"></p>
<p id="p1" class="drg-element-type-standard-field drg-element-sub-type-fieldname-FIRSTNAME addresslabel"><span class="questionlabel "><label for="id1">First Name <font color="red">*</font></label> </span><input
class="drg-field-address-normal" name="demo319128" type="text" value="" id="id1" maxlength="40" size="40"></p>
<p id="p2" class="drg-element-type-standard-field drg-element-sub-type-fieldname-LASTNAME addresslabel"><span class="questionlabel "><label for="id2">Last Name <font color="red">*</font></label> </span><input
class="drg-field-address-normal" name="demo319129" type="text" value="" id="id2" maxlength="40" size="40"></p>
<p id="p10" class="drg-element-type-standard-field drg-element-sub-type-fieldname-TITLE addresslabel"><span class="questionlabel "><label for="id10">Job Title <font color="red">*</font></label> </span><input class="drg-field-address-normal"
name="demo319130" type="text" value="" id="id10" maxlength="40" size="40"></p>
<p id="p3" class="drg-element-type-standard-field drg-element-sub-type-fieldname-COMPANY addresslabel"><span class="questionlabel "><label for="id3">Company</label> </span><input class="drg-field-address-normal" name="demo319131"
type="text" value="" id="id3" maxlength="40" size="40"></p>
<p id="p4" class="drg-element-type-standard-field drg-element-sub-type-fieldname-ADDRESS addresslabel"><span class="questionlabel "><label for="id4">Mailing Address 1 <font color="red">*</font></label> </span><input
class="drg-field-address-normal" name="demo319132" type="text" value="" id="id4" maxlength="255" size="255"></p>
<p id="p5" class="drg-element-type-standard-field drg-element-sub-type-fieldname-DEPARTMENT addresslabel"><span class="questionlabel "><label for="id5">Mailing Address 2</label> </span><input class="drg-field-address-normal"
name="demo319133" type="text" value="" id="id5" maxlength="255" size="255"></p>
<p id="p6" class="drg-element-type-standard-field drg-element-sub-type-fieldname-CITY addresslabel"><span class="questionlabel "><label for="id6">City <font color="red">*</font></label> </span><input class="drg-field-address-normal"
name="demo319134" type="text" value="" id="id6" maxlength="100" size="100"></p><span class="spanc7 drg-element-type-standard-field drg-element-sub-type-fieldname-COUNTRY">
<p id="p7" class="drg-element-type-standard-field drg-element-sub-type-fieldname-COUNTRY addresslabel"><span class="questionlabel "><label for="id7">Country <font color="red">*</font></label> </span><select name="demo319135"
id="id7">
<option value="">Select One</option>
<option value="81" [-selected319135_r81-]="">CANADA</option>
<option value="80" [-selected319135_r80-]="">UNITED STATES</option>
<option value="84" [-selected319135_r84-]="">AFGHANISTAN</option>
<option value="86" [-selected319135_r86-]="">ALBANIA</option>
<option value="87" [-selected319135_r87-]="">ALGERIA</option>
<option value="89" [-selected319135_r89-]="">ANDORRA</option>
<option value="90" [-selected319135_r90-]="">ANGOLA</option>
<option value="91" [-selected319135_r91-]="">ANGUILLA</option>
<option value="350" [-selected319135_r350-]="">ANTARCTICA</option>
<option value="92" [-selected319135_r92-]="">ANTIGUA</option>
<option value="93" [-selected319135_r93-]="">ARGENTINA</option>
<option value="94" [-selected319135_r94-]="">ARMENIA</option>
<option value="95" [-selected319135_r95-]="">ARUBA</option>
<option value="96" [-selected319135_r96-]="">ASCENSION IS</option>
<option value="97" [-selected319135_r97-]="">AUSTRALIA</option>
<option value="98" [-selected319135_r98-]="">AUSTRIA</option>
<option value="99" [-selected319135_r99-]="">AZERBAIJAN</option>
<option value="101" [-selected319135_r101-]="">BAHAMAS</option>
<option value="102" [-selected319135_r102-]="">BAHRAIN</option>
<option value="103" [-selected319135_r103-]="">BANGLADESH</option>
<option value="104" [-selected319135_r104-]="">BARBADOS</option>
<option value="106" [-selected319135_r106-]="">BELARUS</option>
<option value="108" [-selected319135_r108-]="">BELGIUM</option>
<option value="109" [-selected319135_r109-]="">BELIZE</option>
<option value="110" [-selected319135_r110-]="">BENIN</option>
<option value="111" [-selected319135_r111-]="">BERMUDA</option>
<option value="112" [-selected319135_r112-]="">BHUTAN</option>
<option value="113" [-selected319135_r113-]="">BOLIVIA</option>
<option value="115" [-selected319135_r115-]="">BOSNIA-HERZEGOVINA</option>
<option value="116" [-selected319135_r116-]="">BOTSWANA</option>
<option value="117" [-selected319135_r117-]="">BRAZIL</option>
<option value="351" [-selected319135_r351-]="">BRITISH INDIAN OCEAN TERRITORY</option>
<option value="118" [-selected319135_r118-]="">BRITISH VIRGIN IS</option>
<option value="120" [-selected319135_r120-]="">BRUNEI</option>
<option value="121" [-selected319135_r121-]="">BULGARIA</option>
<option value="122" [-selected319135_r122-]="">BURKINA FASO</option>
<option value="123" [-selected319135_r123-]="">BURUNDI</option>
<option value="124" [-selected319135_r124-]="">CAMBODIA</option>
<option value="125" [-selected319135_r125-]="">CAMEROON</option>
<option value="127" [-selected319135_r127-]="">CAPE VERDE ISLANDS</option>
<option value="128" [-selected319135_r128-]="">CAYMAN ISLANDS</option>
<option value="129" [-selected319135_r129-]="">CENTRAL AFRICAN REP</option>
<option value="130" [-selected319135_r130-]="">CHAD</option>
<option value="134" [-selected319135_r134-]="">CHILE</option>
<option value="135" [-selected319135_r135-]="">CHINA</option>
<option value="136" [-selected319135_r136-]="">COCO ISLAND</option>
<option value="137" [-selected319135_r137-]="">COLOMBIA</option>
<option value="138" [-selected319135_r138-]="">COMOROS</option>
<option value="139" [-selected319135_r139-]="">CONGO</option>
<option value="141" [-selected319135_r141-]="">COOK ISLANDS</option>
<option value="142" [-selected319135_r142-]="">COSTA RICA</option>
<option value="143" [-selected319135_r143-]="">CROATIA</option>
<option value="144" [-selected319135_r144-]="">CUBA</option>
<option value="145" [-selected319135_r145-]="">CYPRUS</option>
<option value="146" [-selected319135_r146-]="">CZECH REPUBLIC</option>
<option value="147" [-selected319135_r147-]="">DENMARK</option>
<option value="148" [-selected319135_r148-]="">DJIBOUTI</option>
<option value="149" [-selected319135_r149-]="">DOMINICA</option>
<option value="150" [-selected319135_r150-]="">DOMINICAN REPUBLIC</option>
<option value="151" [-selected319135_r151-]="">EAST TIMOR</option>
<option value="152" [-selected319135_r152-]="">ECUADOR</option>
<option value="153" [-selected319135_r153-]="">EGYPT</option>
<option value="154" [-selected319135_r154-]="">EL SALVADOR</option>
<option value="156" [-selected319135_r156-]="">ERITREA</option>
<option value="157" [-selected319135_r157-]="">ESTONIA</option>
<option value="158" [-selected319135_r158-]="">ETHIOPIA</option>
<option value="159" [-selected319135_r159-]="">FAEROE ISLANDS</option>
<option value="160" [-selected319135_r160-]="">FALKLAND ISLANDS</option>
<option value="161" [-selected319135_r161-]="">FIJI</option>
<option value="162" [-selected319135_r162-]="">FINLAND</option>
<option value="163" [-selected319135_r163-]="">FRANCE</option>
<option value="164" [-selected319135_r164-]="">FRENCH GUIANA</option>
<option value="165" [-selected319135_r165-]="">FRENCH POLYNESIA</option>
<option value="168" [-selected319135_r168-]="">GABON</option>
<option value="169" [-selected319135_r169-]="">GAMBIA</option>
<option value="171" [-selected319135_r171-]="">GEORGIA</option>
<option value="172" [-selected319135_r172-]="">GERMANY</option>
<option value="173" [-selected319135_r173-]="">GHANA</option>
<option value="174" [-selected319135_r174-]="">GIBRALTAR</option>
<option value="176" [-selected319135_r176-]="">GREECE</option>
<option value="177" [-selected319135_r177-]="">GREENLAND</option>
<option value="178" [-selected319135_r178-]="">GRENADA</option>
<option value="179" [-selected319135_r179-]="">GUADELOUPE</option>
<option value="180" [-selected319135_r180-]="">GUATEMALA</option>
<option value="181" [-selected319135_r181-]="">GUERNSEY</option>
<option value="182" [-selected319135_r182-]="">GUINEA</option>
<option value="183" [-selected319135_r183-]="">GUYANA</option>
<option value="184" [-selected319135_r184-]="">HAITI</option>
<option value="185" [-selected319135_r185-]="">HONDURAS</option>
<option value="186" [-selected319135_r186-]="">HONG KONG</option>
<option value="187" [-selected319135_r187-]="">HUNGARY</option>
<option value="188" [-selected319135_r188-]="">ICELAND</option>
<option value="189" [-selected319135_r189-]="">INDIA</option>
<option value="190" [-selected319135_r190-]="">INDONESIA</option>
<option value="191" [-selected319135_r191-]="">IRAN</option>
<option value="192" [-selected319135_r192-]="">IRAQ</option>
<option value="193" [-selected319135_r193-]="">IRELAND</option>
<option value="194" [-selected319135_r194-]="">ISLE OF MAN</option>
<option value="195" [-selected319135_r195-]="">ISRAEL</option>
<option value="196" [-selected319135_r196-]="">ITALY</option>
<option value="197" [-selected319135_r197-]="">IVORY COAST</option>
<option value="198" [-selected319135_r198-]="">JAMAICA</option>
<option value="199" [-selected319135_r199-]="">JAPAN</option>
<option value="200" [-selected319135_r200-]="">JORDAN</option>
<option value="201" [-selected319135_r201-]="">KAZAKHSTAN</option>
<option value="202" [-selected319135_r202-]="">KENYA</option>
<option value="204" [-selected319135_r204-]="">KIRIBATI</option>
<option value="206" [-selected319135_r206-]="">KUWAIT</option>
<option value="207" [-selected319135_r207-]="">KYRGYZSTAN</option>
<option value="208" [-selected319135_r208-]="">LAOS</option>
<option value="209" [-selected319135_r209-]="">LATVIA</option>
<option value="210" [-selected319135_r210-]="">LEBANON</option>
<option value="211" [-selected319135_r211-]="">LESOTHO</option>
<option value="212" [-selected319135_r212-]="">LIBERIA</option>
<option value="213" [-selected319135_r213-]="">LIBYA</option>
<option value="214" [-selected319135_r214-]="">LIECHTENSTEIN</option>
<option value="215" [-selected319135_r215-]="">LITHUANIA</option>
<option value="216" [-selected319135_r216-]="">LUXEMBOURG</option>
<option value="217" [-selected319135_r217-]="">MACAO</option>
<option value="218" [-selected319135_r218-]="">MACEDONIA</option>
<option value="219" [-selected319135_r219-]="">MADAGASCAR</option>
<option value="221" [-selected319135_r221-]="">MALAWI</option>
<option value="222" [-selected319135_r222-]="">MALAYSIA</option>
<option value="223" [-selected319135_r223-]="">MALDIVES</option>
<option value="224" [-selected319135_r224-]="">MALI</option>
<option value="225" [-selected319135_r225-]="">MALTA</option>
<option value="226" [-selected319135_r226-]="">MARSHALL ISLANDS</option>
<option value="227" [-selected319135_r227-]="">MARTINIQUE</option>
<option value="228" [-selected319135_r228-]="">MAURITANIA</option>
<option value="229" [-selected319135_r229-]="">MAURITIUS</option>
<option value="230" [-selected319135_r230-]="">MAYOTTE</option>
<option value="231" [-selected319135_r231-]="">MEXICO</option>
<option value="232" [-selected319135_r232-]="">MICRONESIA</option>
<option value="233" [-selected319135_r233-]="">MOLDOVA</option>
<option value="235" [-selected319135_r235-]="">MONACO</option>
<option value="236" [-selected319135_r236-]="">MONGOLIA</option>
<option value="237" [-selected319135_r237-]="">MONTENEGRO</option>
<option value="238" [-selected319135_r238-]="">MONTSERRAT</option>
<option value="239" [-selected319135_r239-]="">MOROCCO</option>
<option value="240" [-selected319135_r240-]="">MOZAMBIQUE</option>
<option value="241" [-selected319135_r241-]="">MYANMAR</option>
<option value="242" [-selected319135_r242-]="">NAMIBIA</option>
<option value="243" [-selected319135_r243-]="">NAURU</option>
<option value="244" [-selected319135_r244-]="">NEPAL</option>
<option value="245" [-selected319135_r245-]="">NETHERLAND ANTILLES</option>
<option value="246" [-selected319135_r246-]="">NETHERLANDS</option>
<option value="248" [-selected319135_r248-]="">NEW CALEDONIA</option>
<option value="249" [-selected319135_r249-]="">NEW GUINEA</option>
<option value="250" [-selected319135_r250-]="">NEW ZEALAND</option>
<option value="251" [-selected319135_r251-]="">NICARAGUA</option>
<option value="252" [-selected319135_r252-]="">NIGER</option>
<option value="253" [-selected319135_r253-]="">NIGERIA</option>
<option value="254" [-selected319135_r254-]="">NORTH KOREA</option>
<option value="256" [-selected319135_r256-]="">NORWAY</option>
<option value="257" [-selected319135_r257-]="">OMAN</option>
<option value="259" [-selected319135_r259-]="">PAKISTAN</option>
<option value="260" [-selected319135_r260-]="">PALAU</option>
<option value="261" [-selected319135_r261-]="">PALESTINE</option>
<option value="262" [-selected319135_r262-]="">PANAMA</option>
<option value="264" [-selected319135_r264-]="">PARAGUAY</option>
<option value="265" [-selected319135_r265-]="">PERU</option>
<option value="266" [-selected319135_r266-]="">PHILIPPINES</option>
<option value="268" [-selected319135_r268-]="">PITCAIRN IS</option>
<option value="269" [-selected319135_r269-]="">POLAND</option>
<option value="270" [-selected319135_r270-]="">PORTUGAL</option>
<option value="271" [-selected319135_r271-]="">QATAR</option>
<option value="272" [-selected319135_r272-]="">REUNION</option>
<option value="273" [-selected319135_r273-]="">ROMANIA</option>
<option value="274" [-selected319135_r274-]="">RUSSIA</option>
<option value="275" [-selected319135_r275-]="">RWANDA</option>
<option value="276" [-selected319135_r276-]="">SAN MARINO</option>
<option value="277" [-selected319135_r277-]="">SAO TOME E PRINCIPE</option>
<option value="279" [-selected319135_r279-]="">SAUDI ARABIA</option>
<option value="281" [-selected319135_r281-]="">SENEGAL</option>
<option value="282" [-selected319135_r282-]="">SERBIA</option>
<option value="283" [-selected319135_r283-]="">SEYCHELLES</option>
<option value="284" [-selected319135_r284-]="">SIERRA LEONE</option>
<option value="285" [-selected319135_r285-]="">SINGAPORE</option>
<option value="286" [-selected319135_r286-]="">SLOVAK REPUBLIC</option>
<option value="287" [-selected319135_r287-]="">SLOVENIA</option>
<option value="288" [-selected319135_r288-]="">SOLOMON ISLANDS</option>
<option value="289" [-selected319135_r289-]="">SOMALIA</option>
<option value="290" [-selected319135_r290-]="">SOUTH AFRICA</option>
<option value="291" [-selected319135_r291-]="">SOUTH KOREA</option>
<option value="292" [-selected319135_r292-]="">SPAIN</option>
<option value="293" [-selected319135_r293-]="">SRI LANKA</option>
<option value="294" [-selected319135_r294-]="">ST CROIX</option>
<option value="295" [-selected319135_r295-]="">ST KITTS</option>
<option value="296" [-selected319135_r296-]="">ST LUCIA</option>
<option value="298" [-selected319135_r298-]="">ST MARTIN</option>
<option value="299" [-selected319135_r299-]="">ST PIERRE</option>
<option value="300" [-selected319135_r300-]="">ST VINCENT</option>
<option value="301" [-selected319135_r301-]="">SUDAN</option>
<option value="302" [-selected319135_r302-]="">SURINAME</option>
<option value="303" [-selected319135_r303-]="">SWAZILAND</option>
<option value="304" [-selected319135_r304-]="">SWEDEN</option>
<option value="305" [-selected319135_r305-]="">SWITZERLAND</option>
<option value="306" [-selected319135_r306-]="">SYRIA</option>
<option value="308" [-selected319135_r308-]="">TAIWAN</option>
<option value="309" [-selected319135_r309-]="">TAJIKISTAN</option>
<option value="310" [-selected319135_r310-]="">TANZANIA</option>
<option value="312" [-selected319135_r312-]="">THAILAND</option>
<option value="314" [-selected319135_r314-]="">TOGO</option>
<option value="315" [-selected319135_r315-]="">TONGA</option>
<option value="316" [-selected319135_r316-]="">TRINIDAD AND TOBAGO</option>
<option value="317" [-selected319135_r317-]="">TUNISIA</option>
<option value="318" [-selected319135_r318-]="">TURKEY</option>
<option value="319" [-selected319135_r319-]="">TURKMENISTAN</option>
<option value="320" [-selected319135_r320-]="">TURKS ISLAND</option>
<option value="321" [-selected319135_r321-]="">TUVALU</option>
<option value="322" [-selected319135_r322-]="">UGANDA</option>
<option value="323" [-selected319135_r323-]="">UKRAINE</option>
<option value="324" [-selected319135_r324-]="">UNITED ARAB EMIRATES</option>
<option value="749" [-selected319135_r749-]="">UNITED KINGDOM</option>
<option value="325" [-selected319135_r325-]="">URUGUAY</option>
<option value="326" [-selected319135_r326-]="">UZBEKISTAN</option>
<option value="327" [-selected319135_r327-]="">VANUATU</option>
<option value="328" [-selected319135_r328-]="">VATICAN CITY</option>
<option value="329" [-selected319135_r329-]="">VENEZUELA</option>
<option value="330" [-selected319135_r330-]="">VIETNAM</option>
<option value="332" [-selected319135_r332-]="">WALLIS ISLAND</option>
<option value="333" [-selected319135_r333-]="">WESTERN SAHARA</option>
<option value="334" [-selected319135_r334-]="">WESTERN SAMOA</option>
<option value="335" [-selected319135_r335-]="">YEMEN</option>
<option value="336" [-selected319135_r336-]="">ZAIRE</option>
<option value="337" [-selected319135_r337-]="">ZAMBIA</option>
<option value="338" [-selected319135_r338-]="">ZIMBABWE</option>
</select></p>
</span>
<div id="disp319136" style="display:none;"><span class="spanc8 drg-element-type-standard-field drg-element-sub-type-fieldname-STATE">
<p id="p8" class="drg-element-type-standard-field drg-element-sub-type-fieldname-STATE"><span class="questionlabel "><label for="id8">Province <font color="red">*</font></label> </span><select name="demo319136" id="id8">
<option value="">Select...</option>
<option value="67" [-selected319136_r67-]="">ALBERTA</option>
<option value="69" [-selected319136_r69-]="">BRITISH COLUMBIA</option>
<option value="71" [-selected319136_r71-]="">MANITOBA</option>
<option value="73" [-selected319136_r73-]="">NEW BRUNSWICK</option>
<option value="75" [-selected319136_r75-]="">NEWFOUNDLAND AND LABRADOR</option>
<option value="77" [-selected319136_r77-]="">NORTHWEST TERRITORIES</option>
<option value="68" [-selected319136_r68-]="">NOVA SCOTIA</option>
<option value="79" [-selected319136_r79-]="">NUNAVUT</option>
<option value="70" [-selected319136_r70-]="">ONTARIO</option>
<option value="72" [-selected319136_r72-]="">PRINCE EDWARD ISLAND</option>
<option value="74" [-selected319136_r74-]="">QUEBEC</option>
<option value="76" [-selected319136_r76-]="">SASKATCHEWAN</option>
<option value="78" [-selected319136_r78-]="">YUKON TERRITORY</option>
</select></p>
</span></div>
<div id="disp319137" style="display:none;"><span class="spanc8 drg-element-type-standard-field drg-element-sub-type-fieldname-STATE">
<p id="p8" class="drg-element-type-standard-field drg-element-sub-type-fieldname-STATE addresslabel"><span class="questionlabel "><label for="id8">State <font color="red">*</font></label> </span><select name="demo319137" id="id8">
<option value="">Select One</option>
<option value="1" [-selected319137_r1-]="">ALABAMA</option>
<option value="2" [-selected319137_r2-]="">ALASKA</option>
<option value="3" [-selected319137_r3-]="">ARIZONA</option>
<option value="4" [-selected319137_r4-]="">ARKANSAS</option>
<option value="5" [-selected319137_r5-]="">CALIFORNIA</option>
<option value="6" [-selected319137_r6-]="">COLORADO</option>
<option value="7" [-selected319137_r7-]="">CONNECTICUT</option>
<option value="8" [-selected319137_r8-]="">DELAWARE</option>
<option value="9" [-selected319137_r9-]="">DISTRICT OF COLUMBIA</option>
<option value="10" [-selected319137_r10-]="">FLORIDA</option>
<option value="11" [-selected319137_r11-]="">GEORGIA</option>
<option value="12" [-selected319137_r12-]="">HAWAII</option>
<option value="13" [-selected319137_r13-]="">IDAHO</option>
<option value="14" [-selected319137_r14-]="">ILLINOIS</option>
<option value="15" [-selected319137_r15-]="">INDIANA</option>
<option value="16" [-selected319137_r16-]="">IOWA</option>
<option value="17" [-selected319137_r17-]="">KANSAS</option>
<option value="18" [-selected319137_r18-]="">KENTUCKY</option>
<option value="19" [-selected319137_r19-]="">LOUISIANA</option>
<option value="20" [-selected319137_r20-]="">MAINE</option>
<option value="21" [-selected319137_r21-]="">MARYLAND</option>
<option value="22" [-selected319137_r22-]="">MASSACHUSETTS</option>
<option value="23" [-selected319137_r23-]="">MICHIGAN</option>
<option value="24" [-selected319137_r24-]="">MINNESOTA</option>
<option value="25" [-selected319137_r25-]="">MISSISSIPPI</option>
<option value="26" [-selected319137_r26-]="">MISSOURI</option>
<option value="27" [-selected319137_r27-]="">MONTANA</option>
<option value="28" [-selected319137_r28-]="">NEBRASKA</option>
<option value="29" [-selected319137_r29-]="">NEVADA</option>
<option value="30" [-selected319137_r30-]="">NEW HAMPSHIRE</option>
<option value="31" [-selected319137_r31-]="">NEW JERSEY</option>
<option value="32" [-selected319137_r32-]="">NEW MEXICO</option>
<option value="33" [-selected319137_r33-]="">NEW YORK</option>
<option value="34" [-selected319137_r34-]="">NORTH CAROLINA</option>
<option value="35" [-selected319137_r35-]="">NORTH DAKOTA</option>
<option value="36" [-selected319137_r36-]="">OHIO</option>
<option value="37" [-selected319137_r37-]="">OKLAHOMA</option>
<option value="38" [-selected319137_r38-]="">OREGON</option>
<option value="39" [-selected319137_r39-]="">PENNSYLVANIA</option>
<option value="40" [-selected319137_r40-]="">RHODE ISLAND</option>
<option value="41" [-selected319137_r41-]="">SOUTH CAROLINA</option>
<option value="42" [-selected319137_r42-]="">SOUTH DAKOTA</option>
<option value="43" [-selected319137_r43-]="">TENNESSEE</option>
<option value="44" [-selected319137_r44-]="">TEXAS</option>
<option value="45" [-selected319137_r45-]="">UTAH</option>
<option value="46" [-selected319137_r46-]="">VERMONT</option>
<option value="47" [-selected319137_r47-]="">VIRGIN ISLANDS</option>
<option value="48" [-selected319137_r48-]="">VIRGINIA</option>
<option value="49" [-selected319137_r49-]="">WASHINGTON</option>
<option value="50" [-selected319137_r50-]="">WEST VIRGINIA</option>
<option value="51" [-selected319137_r51-]="">WISCONSIN</option>
<option value="52" [-selected319137_r52-]="">WYOMING</option>
</select></p>
</span></div>
<p id="p9" class="drg-element-type-standard-field drg-element-sub-type-fieldname-ZIP addresslabel"><span class="questionlabel "><label for="id9">Postal/Zip Code <font color="red">*</font></label> </span><input
class="drg-field-address-normal" name="demo319138" type="text" value="" id="id9" maxlength="9" size="9"></p>
<p id="p124" class="drg-element-type-standard-field drg-element-sub-type-fieldname-PHONE_MOBILE addresslabel"><span class="questionlabel "><label for="id124">Cell Phone Number</label> </span><input class="drg-field-address-normal"
name="demo319139" type="text" onkeyup="this.value = this.value.replace(/\D/g,'');" value="" id="id124" maxlength="20" size="20"></p><em><span style="font-size: smaller;">By submitting your mobile number, you agree to receive automated
text alerts from Ensemble IQ. Message & data rates may apply. You can opt-out anytime.</span></em>
</section>
</div>
<div class="sixcol last">
<section class="content3"><span class="spanc39 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p39" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id39">
<font color="#666666" face="Helvetica Neue, Helvetica, Arial, sans-serif"><span style="font-size: 13px;">What best describes your primary business?</span></font>
<font color="red">*</font>
</label> </span><select name="demo319141" id="id39">
<option value="">Select...</option>
<option value="347">Department Store</option>
<option value="342">Convenience Store</option>
<option value="5697">Drugstore</option>
<option value="348">General Store</option>
<option value="340">Grocery/Supermarket/Supercenter</option>
<option value="351">Manufacturer/Processor/Distributor of Food and Food Equipment</option>
<option value="350">Distributor/Wholesaler</option>
<option value="344">Voluntary & Co-Operative Groups</option>
<option value="11265">Dollar Store/Extreme Value</option>
<option value="11264">Online Only</option>
<option value="11263">Specialty Store</option>
<option value="353">Other</option>
</select></p>
</span>
<div id="other353" class="otherfillin" style="display: none;">
<p id="p353"><span id="otherfillinid_r353" class="otherfillinlabelomeda">Other</span><input name="demo319141_r353" type="text" value="" id="id_r353" maxlength="50" size="50"></p>
</div><span class="spanc40 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p40" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id40"><label for="id1011"
style="border: 0px; margin: 0px; padding: 0px; color: rgb(102, 102, 102); font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; background-color: rgb(255, 255, 255);">What is your job title?
<font color="red">*</font></label><span style="color: rgb(102, 102, 102); font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; background-color: rgb(255, 255, 255);"> </span>
<font color="red">*</font>
</label> </span><select name="demo319142" id="id40">
<option value="">Select...</option>
<option value="5502">Top Level Executive (C-Suite, President, Owner)</option>
<option value="11271">Director</option>
<option value="5500">Buyer/Category Manager</option>
<option value="401">Store Manager</option>
<option value="402">Retail Sales Associate/Supervisor</option>
<option value="403">Other</option>
<option value="11270">Division/District/General Manager</option>
<option value="11269">EVP/SVP/VP</option>
</select></p>
</span>
<div id="other403" class="otherfillin" style="display: none;">
<p id="p403"><span id="otherfillinid_r403" class="otherfillinlabelomeda">Other</span><input name="demo319142_r403" type="text" value="" id="id_r403" maxlength="50" size="50"></p>
</div><span class="spanc41 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p41" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id41">How many employees are there within your facility? <font color="red">*</font></label> </span><select
name="demo319143" id="id41">
<option value="">Select...</option>
<option value="448">1 - 9</option>
<option value="451">10 - 19</option>
<option value="452">20 - 49</option>
<option value="454">50 - 99</option>
<option value="455">100 - 199</option>
<option value="456">200 - 499</option>
<option value="457">500 - 999</option>
<option value="458">1,000 +</option>
<option value="11073">None of the Above</option>
</select></p>
</span><span class="spanc979 drg-element-type-demographic drg-element-sub-type-type-5">
<p id="p979" class="drg-element-type-demographic drg-element-sub-type-type-5"><span class="questionlabel ">Are you at least 18 years old or older? <font color="red">*</font> </span></p>
<ul>
<li class="licr979_6121 lier319144_6121 "><input name="demo319144" type="checkbox" value="6121" id="id979_6121"><span class="checkboxlabel"><label for="id979_6121">Yes</label></span></li>
<li class="licr979_6122 lier319144_6122 "><input name="demo319144" type="checkbox" value="6122" id="id979_6122"><span class="checkboxlabel"><label for="id979_6122">No</label></span></li>
</ul>
</span>
</section>
</div>
</section>
<section class="row">
<div class="twelvecol">
<section class="content4"><span class="spanc970 drg-element-type-demographic drg-element-sub-type-type-5">
<p id="p970" class="drg-element-type-demographic drg-element-sub-type-type-5"><span class="questionlabel ">Privacy Policy <font color="red">*</font> </span></p>
<ul>
<li class="licr970_6008 lier319145_6008 "><input name="demo319145" type="checkbox" value="6008" id="id970_6008"><span class="checkboxlabel"><label for="id970_6008">I accept Ensemble IQ
<a href="https://ensembleiq.com/terms-and-conditions">Terms and Conditions</a> and acknowledge that my information will be used in accordance with Ensemble IQ
<a href="https://ensembleiq.com/privacy-policy">Privacy Policy</a>.</label></span></li>
</ul>
</span>
<div id="disp319146" style="display:none;"><span class="spanc10263 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p10263" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "> </span></p>
<ul>
<li class="licr10263_9971 lier319146_9971 "><input name="demo319146" type="radio" value="9971" id="id10263_9971"><span class="radiolabel"><label for="id10263_9971">Do not sell my personal information.</label></span></li>
</ul>
</span></div><br>
<hr><br>
<div id="disp319148" style="display:none;"><span class="spanc112 drg-element-type-standard-field drg-element-sub-type-fieldname-REQUESTED_VERSION">
<p id="p112" class="drg-element-type-standard-field drg-element-sub-type-fieldname-REQUESTED_VERSION"><span class="questionlabel "><strong>Please choose your subscription:</strong>
<font color="red">*</font>
</span></p>
<ul>
<li class="licr112_998 lier319148_998 "><input name="demo319148" type="radio" value="998" id="id112_998" [-checked319148_r998-]=""><span class="radiolabel"><label for="id112_998">Print</label></span></li>
<li class="licr112_999 lier319148_999 "><input name="demo319148" type="radio" value="999" id="id112_999" [-checked319148_r999-]=""><span class="radiolabel"><label for="id112_999">Digital</label></span></li>
<li class="licr112_1000 lier319148_1000 "><input name="demo319148" type="radio" value="1000" id="id112_1000" [-checked319148_r1000-]=""><span class="radiolabel"><label for="id112_1000">Print + Digital</label></span></li>
</ul>
</span></div>
<div id="disp319149" style="display:none;"><span class="spancp258 drg-element-type-product drg-element-sub-type-type-1">
<p id="pp258" class="drg-element-type-product drg-element-sub-type-type-1"><span class="questionlabel ">You also qualify to receive a <u>complimentary</u> subscription to our sister publication, <strong>Convenience Store News Canada
& Octane</strong>. </span></p>
<ul>
<li class="licrp258_1 lier319149_1 "><input name="opt319149" type="radio" value="1" id="optid258_1"><span class="radiolabel"><label for="optid258_1">Yes, I'd like to subscribe to <strong>Convenience Store News Canada &
Octane</strong> magazine.</label></span></li>
</ul>
</span></div>
<div id="disp319150" style="display:none;"><input name="demo319150" type="hidden" value="" id="demo319150"></div>
<div id="disp319151" style="display:none;"><input name="demo319151" type="hidden" value="" id="demo319151"></div>
<div id="disp319152" style="display:none;"><input name="demo319152" type="hidden" value="" id="demo319152"></div>
<div id="disp319153" style="display:none;"><input name="demo319153" type="hidden" value="" id="demo319153"></div>
<div id="disp319154" style="display:none;"><input name="demo319154" type="hidden" value="5569" id="demo319154"></div>
<div id="disp319155" style="display:none;"><input name="opt319155" type="hidden" value="1" id="optp10021"></div>
<div id="disp319156" style="display:none;"><input name="opt319156" type="hidden" value="1" id="optp10019"></div>
<div id="disp319157" style="display:none;"><input name="opt319157" type="hidden" value="1" id="optp314"></div>
<div id="disp319158" style="display:none;"><input name="opt319158" type="hidden" value="1" id="optp10039"></div>
<div id="disp319159" style="display:none;"><input name="opt319159" type="hidden" value="1" id="optp10020"></div>
<div id="disp319160" style="display:none;"><input name="opt319160" type="hidden" value="1" id="optp301"></div>
<div id="disp319161" style="display:none;"><input name="opt319161" type="hidden" value="1" id="optd268"></div>
<div id="disp319162" style="display:none;"><input name="opt319162" type="hidden" value="1" id="optd269"></div>
<div id="disp319163" style="display:none;"><input name="opt319163" type="hidden" value="1" id="optd247"></div>
<div id="disp319164" style="display:none;"><input name="opt319164" type="hidden" value="1" id="optd248"></div>
<div id="disp319165" style="display:none;"><input name="opt319165" type="hidden" value="1" id="optd246"></div>
<div id="disp319166" style="display:none;"><input name="opt319166" type="hidden" value="1" id="optd249"></div>
<div id="disp319167" style="display:none;"><input name="opt319167" type="hidden" value="1" id="optd238"></div>
<div id="disp319168" style="display:none;"><input name="opt319168" type="hidden" value="1" id="optp169"></div>
<div id="disp319169" style="display:none;"><input name="opt319169" type="hidden" value="1" id="optp10045"></div>
<div id="disp319170" style="display:none;"><input name="opt319170" type="hidden" value="1" id="optp206"></div>
<div id="disp319171" style="display:none;"><input name="opt319171" type="hidden" value="1" id="optp347"></div>
<div id="disp319172" style="display:none;"><input name="opt319172" type="hidden" value="1" id="optp10093"></div>
<div id="disp319173" style="display:none;"><input name="opt319173" type="hidden" value="1" id="optp10146"></div>
<div id="disp319174" style="display:none;"><input name="opt319174" type="hidden" value="1" id="optd184"></div>
<div id="disp319175" style="display:none;"><input name="opt319175" type="hidden" value="1" id="optd4"></div>
<div id="disp319176" style="display:none;"><input name="opt319176" type="hidden" value="1" id="optd172"></div>
<div id="disp319177" style="display:none;"><input name="opt319177" type="hidden" value="1" id="optd173"></div>
<div id="disp319178" style="display:none;"><input name="opt319178" type="hidden" value="1" id="optd169"></div>
<div id="disp319179" style="display:none;"><input name="opt319179" type="hidden" value="1" id="optd170"></div>
<div id="disp319180" style="display:none;"><input name="opt319180" type="hidden" value="1" id="optd171"></div>
</section>
</div>
</section>
<section class="row">
<div class="twelvecol last">
<section class="submit">
<input type="submit" value="Submit" id="custombtn">
</section>
</div>
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Go to... NEW SUBSCRIPTION * Your Information * Your Profile * Confirmation Fields with an * are required. Email Address * First Name * Last Name * Job Title * Company Mailing Address 1 * Mailing Address 2 City * Country * Select OneCANADAUNITED STATESAFGHANISTANALBANIAALGERIAANDORRAANGOLAANGUILLAANTARCTICAANTIGUAARGENTINAARMENIAARUBAASCENSION ISAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA-HERZEGOVINABOTSWANABRAZILBRITISH INDIAN OCEAN TERRITORYBRITISH VIRGIN ISBRUNEIBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCAPE VERDE ISLANDSCAYMAN ISLANDSCENTRAL AFRICAN REPCHADCHILECHINACOCO ISLANDCOLOMBIACOMOROSCONGOCOOK ISLANDSCOSTA RICACROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICEAST TIMORECUADOREGYPTEL SALVADORERITREAESTONIAETHIOPIAFAEROE ISLANDSFALKLAND ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUATEMALAGUERNSEYGUINEAGUYANAHAITIHONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELANDISLE OF MANISRAELITALYIVORY COASTJAMAICAJAPANJORDANKAZAKHSTANKENYAKIRIBATIKUWAITKYRGYZSTANLAOSLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIAMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIAMOLDOVAMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLAND ANTILLESNETHERLANDSNEW CALEDONIANEW GUINEANEW ZEALANDNICARAGUANIGERNIGERIANORTH KOREANORWAYOMANPAKISTANPALAUPALESTINEPANAMAPARAGUAYPERUPHILIPPINESPITCAIRN ISPOLANDPORTUGALQATARREUNIONROMANIARUSSIARWANDASAN MARINOSAO TOME E PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAK REPUBLICSLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH KOREASPAINSRI LANKAST CROIXST KITTSST LUCIAST MARTINST PIERREST VINCENTSUDANSURINAMESWAZILANDSWEDENSWITZERLANDSYRIATAIWANTAJIKISTANTANZANIATHAILANDTOGOTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS ISLANDTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMURUGUAYUZBEKISTANVANUATUVATICAN CITYVENEZUELAVIETNAMWALLIS ISLANDWESTERN SAHARAWESTERN SAMOAYEMENZAIREZAMBIAZIMBABWE Province * Select...ALBERTABRITISH COLUMBIAMANITOBANEW BRUNSWICKNEWFOUNDLAND AND LABRADORNORTHWEST TERRITORIESNOVA SCOTIANUNAVUTONTARIOPRINCE EDWARD ISLANDQUEBECSASKATCHEWANYUKON TERRITORY State * Select OneALABAMAALASKAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFLORIDAGEORGIAHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTAOHIOOKLAHOMAOREGONPENNSYLVANIARHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING Postal/Zip Code * Cell Phone Number By submitting your mobile number, you agree to receive automated text alerts from Ensemble IQ. Message & data rates may apply. You can opt-out anytime. What best describes your primary business? * Select...Department StoreConvenience StoreDrugstoreGeneral StoreGrocery/Supermarket/SupercenterManufacturer/Processor/Distributor of Food and Food EquipmentDistributor/WholesalerVoluntary & Co-Operative GroupsDollar Store/Extreme ValueOnline OnlySpecialty StoreOther Other What is your job title? * * Select...Top Level Executive (C-Suite, President, Owner)DirectorBuyer/Category ManagerStore ManagerRetail Sales Associate/SupervisorOtherDivision/District/General ManagerEVP/SVP/VP Other How many employees are there within your facility? * Select...1 - 910 - 1920 - 4950 - 99100 - 199200 - 499500 - 9991,000 +None of the Above Are you at least 18 years old or older? * * Yes * No Privacy Policy * * I accept Ensemble IQ Terms and Conditions and acknowledge that my information will be used in accordance with Ensemble IQ Privacy Policy. * Do not sell my personal information. -------------------------------------------------------------------------------- Please choose your subscription: * * Print * Digital * Print + Digital You also qualify to receive a complimentary subscription to our sister publication, Convenience Store News Canada & Octane. * Yes, I'd like to subscribe to Convenience Store News Canada & Octane magazine. Your name and address information including email address will be used to correspond with you regarding your subscription, and to send you newsletters and other relevant information. Please view our full Privacy Policy for more details. To contact customer care, please email contactus@canadiangrocer.com or call 1-877-687-7321. <%-- the gray background --%> Yes No