HIRA News

Latest News & Announcements
2011 HIRA Annual Conference
Program Agenda and Power Point Presentations		 More Info >>
New Article: “Sweating Out the Pursuit of a Cool Commission”  by Adam Glazer More Info >>
New Article:  Repertiore Magazine “Pavilion Participation” More Info >>

 

Manufacturer Membership Application

Allied membership shall be available to manufacturers in the health care industry who currently, or who have announced plans to, market via independent contractor sales representatives. Policies governing the participation of Allied members shall be determined by the Board of Directors of the Association.

= Required Field

Company Name:
Company Delegate to HIRA:
Title:
Address:
City:
State or Province:
Zip:
Phone:
Cell Phone:
Work Phone:
Fax:
E-mail:
Website:
Registered Trade Name:
# of Years in Business:

Type of Business:

How did you hear about HIRA?

Did a HIRA member refer you?



If yes, Who?

Company Officers: Those Involved in Sales & Marketing
Name: Title:
Name: Title:
Name: Title:

Products Manufactured:

Please mark any of the following markets into which your product(s) are sold:


        
       

Have you used Independent Reps in the past?


Do you currently use Independent Reps?

Indicate States or Provinces, if any, serviced by your own direct personnel:

Is this because you:

States or Provinces currently open for representation:

SPONSOR: If a HIRA member is sponsoring your Application, please indicate who below:
Sponsor Name:
Sponsor Firm Name:

Manufacturer Membership is $545.00 per year. You will be prompted by Paypal to pay your membership dues after you click submit.