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HITX

Thank you for your interest in the
US-Israel Healthcare IT Business Exchange, June 8-9, 2010.

Please complete the application below.
You will be contacted regarding your application and registration.

Participation Costs:

Registration: $1,950 - includes: 1 participant at all event functions (inc. hotel night), AICC "Business" level membership

$250 for each additional person + hotel ($135/night).

To register for the Gala Reception only, Click Here.
Company Name
Company Website

Company Address
(Full mailing address)
Contact Name (Last)
Contact E-mail
(First)
Contact Telephone (Work)
Contact Telephone (Mobilel)



Primary Attendee Name (Last)
Primary Attendee E-mail
(First)
Primary Attendee Telephone (Work)
Primary Attendee Title
Primary Attendee Telephone (Mobile)
(Please list name as it appears on your passport)

Additional Attendees

Attendee 1 Name (Last)
Attendee 1 E-mail
(First)
Attendee 1 Telephone (Work)
Attendee 1 Title
Attendee 1 Telephone (Mobile)
(Please list name as it appears on your passport)

Attendee 2 Name (Last)
Attendee 2 E-mail
(First)
Attendee 2 Telephone (Work)
Attendee 2 Title
Attendee 2 Telephone (Mobile)
(Please list name as it appears on your passport)

If you have additional people that would like to attend, please email guy@aiccse.org



Please provide information about your company in a format
that can be presented to prospective clients or partners

Description of your company
Description of your goals for this event
The status of your company
in terms of product, financing,
US offices and activities, etc.
Who are your current customers?

If you have additional questions, please contact Guy Tessler at guy@aiccse.org

  



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