PARTNERS IN HEALTH INFORMATION TECHNOLOGY 2008

Washington, DC - March 25-27, 2008

Registration Deadline: Monday, February 15, 2008

Company Profile and Registration

Before you continue

This form is compatible with Internet Explorer on a PC. If using a Mac or a different browser such as Firefox, please click here.
Required information: Your company profile*, your company logo in JPG format, and your passport details. Your company logo must be sent separately via e-mail.
This trade mission is open only to Canadian vendors/manufacturers.
Within two business days of submitting your details, you will receive e-mail confirmation that your registration is complete. If you do not receive this confirmation, please contact Cynthia.Stevenson@international.gc.ca.

*Required Fields

Participant Information

*Participant #1 - Name:
*Participant #1 - Title:
*Participant #1 - E-Mail:
Passport information is required for access to some secure site visit locations. If you are not comfortable sending this data via this internet form, please e-mail Cynthia.Stevenson@international.gc.ca or fax (202) 682-7789 your details, and please enter "via e-mail" or "via fax" in each of the fields below. If you do not have a passport, please enter your Social Insurance (SIN), and one additional type of identification in the boxes below, and enter "none" in those you do not fill in.
*Participant #1 - Passport Number:
*Full Name on Passport:
*Nationality:
*Place of Birth:
*Date of Birth:
*Place of Passport Issue:
*Date of Passport Issue:
Participant #2 - Name:
Participant #2 - Title:
Participant #2 - E-Mail:
Participant #2 - Passport Number:
Full Name on Passport:
Nationality:
Place of Birth:
Date of Birth:
Place of Passport Issue:
Date of Passport Issue:

Program Participation

Participating Canadian companies must be known to the Trade Commissioner Service of the Department of Foreign Affairs and International Trade. A representative will contact you to confirm your eligibility. As space is limited to 15 companies, registrations will be taken on a first-come basis.

Participating companies must pay their own travel and shipping expenses related to this program. Due to security and storage limitations, arrangements must be made for materials and display items to be shipped to the Embassy to arrive no later than Monday, March 21, 2008.

Questions? Contact Cynthia Stevenson, Trade Commissioner at (202) 682-7765 or Cynthia.Stevenson@international.gc.ca

*Company Name:
Address:
*Telephone:
Facsimile:
Company Website:
Is your company presently doing business in the U.S.?	Yes No

Please provide your company profile for meetings with U.S. business partners by downloading this MS Word* template and e-mailing it to: Cynthia.Stevenson@international.gc.ca when completed. You may also print and fax the completed form to (202) 682-7789.
Have you sent your company logo in JPEG format in an e-mail to Cynthia.Stevenson@international.gc.ca?	Yes No