HIMSS19 Start-Up Qualification Survey

HIMSS19 Qualification Survey
for Start-Up Exhibiting Companies

HIMSS is committed to promoting health technology innovation and providing showcase opportunities for early- to growth-stage companies within the Innovation Live and Personalized Health Experience areas at HIMSS19.

HIMSS19 offers affordable exhibiting options for pre-qualifying startup companies to help raise brand awareness, market visibility, and encourage networking for business-building opportunities with entrepreneurs and potential investors.

Please complete the following questions. The HIMSS Sales team will contact qualifying companies with information on exhibiting in the HIMSS19 Innovation Live and/or Personalized Health Experience areas.

*Demographic Information

Your Name:

*Title:

*Email:

*Phone:

*Name of Company:

*Website:

*Address:

*Please fully complete the following questions:

Year Founded:

*Number of Employees:

*Description of product/service offering:

*Are you affiliated with a business incubator or accelerator?

	No
	Yes

*Actively Seeking Funding?

	No
	Yes

Funding Stage:

	Angel
	Series A
	Series B
	Series C

Comments: