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 >>

 

Representative Membership Application

Membership in this Association shall be composed of those firms, corporations, partnerships or individuals which have operated for more than one (1) year. If you do not satisfy that criteria, we will accept one (1) year’s experience in the healthcare field plus sponsorship by three (3) current HIRA members. In addition to the experience and sponsorships, the applicant must be performing the function of an independent contractor sales representative for two (2) or more principals who manufacture healthcare products. He/She must not have engaged, and agree not to engage, in any activity prohibited by the association’s Code of Ethics.

Firm Name:
Name of Firm's Delegate to Assn.:
Title:
Nickname for Conference Badge:
Delegate's Spouse's Name:
Mailing Address:
City:
State or Province:
Zip Code:
E-mail Address:
Web Site:

Telephone Numbers:

Business Telephone Number:
Fax Number:
Home Telephone Number:
Cell Phone Number:

Year Firm Founded:
Number of Salespeople:
Number of Inside Employees:
Principals of the Firm:

How did you hear about HIRA?

Did a HIRA member refer you?



If yes, Who?

Territory Covered (List states or provinces - whole or parts):

List all manufacturers you represent (Two REQUIRED for membership - this information is held strictly confidential):
1. Name:
Address:
Key Contact:
Phone:
 
2. Name:
Address:
Key Contact:
Phone:
 
3. Name:
Address:
Key Contact:
Phone:

Please enter any additional manufacturers here:

Do you as a representative own any interest in a company that manufactures products in the health care industry?
 

If yes, give the firm's name:

Do you as a representative own any part of a health care distributing company?

If yes, give the firm's name:

Do you have warehouse facilities available?

Do you invoice any lines?

If yes, list lines:

This information is for the directory - Our firm markets products to the following categories (check):
                                                  

Have you read, and do you subscribe to, the Association's "Code of Ethics"?

SPONSOR: Please indicate if a HIRA member is sponsoring your application. Three (3) HIRA Member sponsors are required if the firm applying has been in operation less than one (1) year.

Sponsor Name: Firm Name:
Sponsor Name: Firm Name:
Sponsor Name: Firm Name:

Representative Membership is $350.00 per year. You will be prompted by Paypal to pay your membership dues after you click submit.