CORPORATE EXECUTIVE OFFICE PROGRAM –
Dusseldorf, Germany – November 16-19, 2015
FAX REGISTRATION FORM & Credit Card Info:
It is a pleasure to welcome you to the U.S. and Foreign Commercial Service's Corporate Executive Office (CEO) Program for MEDICA 2015. We at the U.S. Department of Commerce and the U.S. Consulate General in Dusseldorf look forward to providing you strong support in your efforts to generate sales in the German and European markets.
Please provide the information requested below to assure your participation in the CEO program for MEDICA 2015. The registration form should be received, by August 14th if possible, to allow inclusion in MEDICA Catalog, by our U.S. Consulate General, Attn: Ms. A. Salama, Willi-Becker-Allee 10, 40227 Düsseldorf, Germany. Please provide:
Cardholder name: ______________________________
Credit Card: ____Mastercard, ____Visa, ____American Express, or ____Discover
Card number: _________________________________
Expiration date: ___________
Cancellation Policy: 50% of the participation fee will be returned if the Commercial Service Dusseldorf Office is notified in writing prior to September 16, 2015. After this date, all fees are non-refundable. The CEO program is designed to assist new small to medium sized companies from the United States. For this reason, new U.S. SMEs have priority consideration and US firms that have participated in the program for more than three years will only be considered under extenuating circumstances and only if all new companies have been accommodated.
CONTACT PERSON: ____________________________ TITLE:___________________________________
ADDRESS: __________________________ CITY __________________ STATE _________ ZIP _________
TELEPHONE: ________________ FAX: ________________ E-MAIL: ______________________________
New-to-Market _____ New-to-Export _____ Old-to-Market _____
No. of Employees: ________________________ Minority-Owned: ____Yes ____No
NUMBER OF COMPANY PARTICIPATING REPRESENTATIVES AT MEDICA: _________
Names of Company Reps: ______________________________ ______________________________
MEDICA 2015 PARTICIPATION DATES: NOVEMBER 16-19, 2015
FEE: $ 6000 FOR FOUR DAYS
$ 6800 PREMIUM RATE FOR PRIVATE ROOM
ARE YOU CURRENTLY REPRESENTED IN GERMANY? ____YES ____ NO
PLEASE LIST OTHER EUROPEAN COUNTRIES IN WHICH YOU ARE REPRESENTED:
Countries you are TARGETING FOR EXPORT IN NEXT 12-18 MONTHS? _____________________________
Please provide us information to assist in promoting your company's business goals in Germany and Europe: i.e.
1. a summary of your medical product line; 2. please identify what sort of firms we should target as the highest potential distributors or end-users. Please use a separate page, if possible. This information will be translated into German to advertise your firm’s presence at MEDICA.
Should you have any questions, please feel free to contact our Commercial Service Staff:
In Germany: Anette Salama - Germany's MEDICA team lead: Anette.Salama@trade.gov.
TEL: 011-49-211-737-767-60 FAX: 011-49-211-737-767-67
In the United States: Sandra Campbell – U.S. MEDICA team lead: Sandra.Campbell@trade.gov TEL: 727-893-3738