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Hospitalar 2014
Participate at Hospitalar, the largest medical event in Latin America. (Official Marketing Flyer - PDF)
To verify if you can qualify for our matchmaking service, please fill out the form. U.S. companies only.
Fields marked with * are required.
OMB Control No.: 0625-0237
Expiration Date: 1/1/12

COMPANY INFORMATION

Company*  
Address:*  
City:*  
State*:  
Zip Code:*  
Country:*  
Telephone*:  
Fax:  
Web Site:*  

PRIMARY COMPANY REPRESENTATIVE (Highest ranking member of group.)

Full Name:*  
Title:*  
Telephone:*    Ext.
Mobile Phone:*  
Email:*     
Administrative contact name:  
Administrative contact email:     

ADDITIONAL COMPANY REPRESENTATIVE (Optional)

Full Name:  
Title:  
Telephone:     Ext.
Mobile Phone:  
Email:      
Administrative contact name:  
Administrative contact email:     
     
COMPANY PROFILE
Year your company was established:*
 
Type of company:*
               Manufacturer
               Distributor
               Export trading company
               Service
               Other
 
Sales method:*
               Direct
               Agents
               Distributors
               Joint Venture
               Other
 

*Is your product/service at least 51% U.S. content?*
Yes    No
 
Percentage export:*  
Number of Employees*:  

*Do you have an export promotional budget?
Yes    No

PRODUCT/SERVICE INFORMATION
 
Product/Service name*:  

Please indicate the industry your product/service is used in*

Please describe your product/service:

Please describe the primary users of your product/service:
     


Public reporting for this collection of information is estimated to be 5 minutes per response, including the time for reviewing instructions, and completing and reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentially to the extent allowed by law. Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Clearance Officer, International Trade Administration, Department of Commerce, Room 4001, 14th and Constitution Avenue, N.W., Washington, D.C. 20230.