b2b encounters | Supplier Registration Form
Thank you for your interest in our event. In order to make this gathering more effective, please fill in the below form to start your registration process. Sending this form does not automatically gets you registered. We have a very strict selection process. Your registration is subject to approval after evaluation. So please be ready to provide some extra information about your company after our response to your registration inquiry.
Sign in to Google to save your progress. Learn more
Company Information
Name of your company / institution *
As you want it to appear on the guide-book and on your table
Short introduction and information about your hospital / clinic *
Approximately 120 words please
Exclusive Technology
Please mention one or a few of the interesting or rare technologies that your hospital has.
The strongest fields of your hospital for international patients.
Cardiology, gynecology, urology etc.
Countries that you get most of your international patients from?
Please mention your top markets
Address *
Phone
E-mail *
Website address
Accreditations
If available
Additional Information
The more, the merrier. Please fill as many as these fileds.
News or slogans
Short phrases like your mottos or things that you want to highlight. i.e: 'Opening a new branch in 2013' or 'We welcome everyone with a smile'
Number of branches
How many hospitals, clinics or medical centers you have all together
Any International branches?
Facilities outside of your home country
Number of medical doctors
Number of Medical staff
Indoor area of your main facility
How many square meters?
1st Delegate Information
Name *
Surname *
Title / Position *
Languages *
E-Mail *
Phone
2nd Delegate Information
Name
Surname
Title / Position
Languages
E-Mail
Phone
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms