Apply Online

Southeast Emerging Companies
$1,200 for 1 person; $150 for each additional person (does not include hotel accomodations - Click for hotel information)

Each person to register is automatically registered for the Gala Reception on June 16, 2008.

Click to register for the Gala Reception only

Thank you for your interest in the US-Israel Telehealth Business Exchange,June 16-17, 2008

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

 

Company Name
Company Website

Company Address
(Full mailing address)

CEO Name (Last)
CEO E-mail
(First)
CEO Telephone (Work)
CEO Telephone (Cell)



Primary Attendee Name (Last)
Primary Attendee E-mail
(First)
Primary Attendee Telephone (Work)
Primary Attendee Title
Primary Attendee Telephone (Cell)
(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 (Cell)
(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 (Cell)
(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?


Please indicate below the ten companies you are MOST interested in meeting and your objective.
(i.e. investment, marketing alliance, joint venture, R & D, customer relationship, etc.)

US Company Name
Objective for Meeting

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

  



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