-:Application to be part of the IIMTC Hosted Buyer Programme:-

First Name *

Last Name: *

Mobile No: *

Destination: *



State: *

Zip Code/Postal Code: *

Country *

Your Email *

Company Name:


50 word company profile :

How many patients are being sent on a monthly basis? :

Which region are your patients coming from mainly? :

Where are you sending the patients to? (Maximum of 100 words only) :

Which procedures/treatments are you sending patients for predominantly?:

Which medical centres would you like to meet with at IIMTC? (Maximum of 100 words only) :

Buyer Profile :

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