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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: $250 Includes 1 person

$150 for each additional person

Hotel - $135/night (optional)

To register for the Gala Reception only (June 8th) Click Here.

Company & Primary Contact

Company Name Company Website
Last Name First Name
Work Telephone Mobile
E-mail Title
Company Address
(Full mailing address)

Please describe your

primary business

objective for this event




Primary Attendee Information

Last Name   First Name
Title   E-mail
Work Telephone   Mobile



Additional Attendees Information

Attendee 1 Attendee 2
Last Name Last Name
First Name First Name
Title Title
E-mail E-mail
Work Telephone Work Telephone
Mobile Mobile

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

  



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