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Please fill in all sections
Prefix:
Mr
Mrs
Ms
Dr
Name on badge:
Designation:
Company:
Address:
Postal Code:
Town/City:
Country:
Tel:
Fax:
Email:
Mobile:
I am interest in visiting :
SE-Asian Healthcare Show
SE-Asian Pharma
SE-Asian Medical Beauty
1.
Your main business/industry:
Select..
Healthcare
Medical Beauty/Wellness
Pharmaceutical Manufacturing/Marketing
Other (Please specify below)
Other:
2.
Do you have direct purchasing influence ?
Select..
Yes
Initial Recommendation
No
3.
Which sector do you represent ?
Select..
Government
Private
4.
Where are you from ?
Select..
Malaysia
Singapore / SE-Asia
Rest of Asia/Australia
Europe
Americas
Elsewhere
Elsewhere:
5.
Which of the following best describes your job function ?
Select..
Beautican
Consultant to Beauty Industry
Consultant/Director
Contract Research
Dietician
Doctor/Surgeon
Engineering and Maintainence
IT Systems
Middle Management
Nursing
Pharmacist/Retail
Procurement of Supplies
Quality Control
Senior Management in Healthcare Facility
Senior Management in Pharma Facility
Senior Management in Private Organisation
Other (Please specify below)
Other:
6.
Which of the following best describes your organisation ?
Operator of
:
Select..
Clinic
Dental
Hospital
Laboratory
Manufacturer of
Distributor of
Select..
Disposables
Hospital Equipment
Laboratory
Medical Devices
Rehab
Others (Please specify below)
Other:
Manufacturer of
Distributor of
Select..
Bulk Durgs-Ingredients
Herbals
Pharamaceuticals-DTC
Processing/Packing Equipment
Others (Please specify below)
Other:
Operator of:
Select..
Clinic/Salon
Fitness
Retail Outlet
Wellness/Spa
Manufacturer of
Distributor of
Wholesaler of
Select..
Medical Beauty Equipment
Personal Care
Others (Please specify below)
Other:
7.
Which of the following best describes the purpose of your visit ?
Select..
To seek representatives
To Purchase
To Visit Suppliers
To Gather Information
To Evaluate for Future Participation
Other:
8.
Exhibitors may send me advance information/invitation to visit their booth:
Yes
No
9.
I would like to be kept informed via Email updates:
Yes
No
10.
I would like to receive SMS reminders:
Yes
No
or
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