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MEDICA 2013 E-Showtime Appointment Schedule
Register here to meet with Commercial Specialists from around the world at MEDICA, November 20-23, 2013.
Fields marked with * are required.
OMB Control No.: 0625-0237
Expiration Date: 6/7/13
Contact First Name:*  
Contact Last Name:*  
Title within Organization:*  
Email Address:*  
Daytime Phone Number:  
Fax Number:  
Mobile Number:  
Organization Type:


Organization Name:*  
Organization Web Site:  
Organization Address 1:*  
Organization Address 2:  
Organization City:*  
Organization State:  
Organization Country:*  
Organization Zip Code:  
Number of employees in Business:*  
Estimated Annual Sales:*  

Select Your Industry:*

Organization/Product/Service Description:

Does U.S. content represent at least 51% of the value of the finished product?   Yes  No
Year Organization Was Established:  
Are you currently exporting?                              
Yes  No
Estimated Percentage of Annual Sales Derived from Exporting:
If not the manufacturer, does your firm have documented sales or distribution authorization for the product?

Yes  No  Not Applicable

Do you have an export promotional budget?
Yes  No
Have you participated in any of the following CS services in the last two years?

Product/Service Name:

Select the most important end-user industries for this product:

Product/Service Description:

List the most important end-users for this product:

Meeting Name:  
Meeting Date:  
Meeting Location:  

Please select the international markets for which you would like to meet with our industry specialist. The average duration of each appointment is 20-30 minutes.
Country - Belgium
Country - Belgium (EU/Standards)
Country - Czech Republic
Country - Denmark
Country - Finland
Country - France
Country - Germany
Country - Ireland

Country - Israel
Country - Italy
Country - Japan
Country - Russia
Country - Saudi Arabia
Country - Serbia
Country - Sweden
Country - United Kingdom


How will you participate in the event?

Visitor Exhibitor

If you are an exhibitor, which is your booth number?  
Available to meet on specified date?  

Yes  No  

Preferred Time of Meeting?  
Any dates or times you are not available for meetings?  

Are you currently working with a United States Export Assistance Center?
(a.k.a., International Trade Administration, U.S. Commercial Service, Department of Commerce)

Yes  No  

If yes, please provide the name of the International Trade Specialist:
In the last 24 months, have you or your company used any market research reports or trade promotion programs, or received counseling from a U.S. Export Assistance Center, Department of Commerce, U.S. Embassy or other government organization?

Yes  No  

If yes, has the program or information provided assisted you in completing your export sales?

Yes  No  

If time allows, could you please explain?


Public reporting for this collection of information is estimated to be 5 minutes per response, including the time for reviewing instructions, and completing and reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentially to the extent allowed by law. Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Clearance Officer, International Trade Administration, Department of Commerce, Room 4001, 14th and Constitution Avenue, N.W., Washington, D.C. 20230.