VIP Buyers

VIP BUYERS

Important Note: It is important you provide as much information as possible so that your application can be reviewed by the committee. If you do not provide complete and detail information on the application your VIP application will be denied for lack of information. Please answer each question with multiple sentences, Do not leave any question Blank or put *N/A or not applicable.* This will disqualify you.

* 1. Please enter the following information:

First Name:

Last Name:

Address:

City/Town:

State/Province:

Zip/Postal Code:

Country:

Email Address:

Phone Number:

* 2. Please enter the following information about your current position:

Company Name:

Job Title:

Company Website:

* 3. Please select your business type:

Insurance Company

Employer - Benefits Manager

TPA

Health Insurance Agent, Consultant or Broker

Travel Agent

Medical Tourism Facilitator

Hospital/Clinic, Government or Healthcare Provider

Other (please specify)