Virtual Networking Package Monthly Membership Form

Virtual Networking Package - Monthly Membership Form

Online Monthly Networking Sessions
Full Name:*

First NameLast Name
Job Title:*
Role:
If other Role Please Specify Below:
Company Name:
Email:*
example@example.com
Mobile No:*
Please enter you phone number here.
Work No:
Please enter you phone number here.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who would you most benefit from connecting with:
Please Note: As part of your Virtual Networking Package for £19 Per Month when you join the Healthcare Integrated Network Platform you will also automatically get the following:
- Access to virtual networking events – unlimited
- Access to HIN webinars - unlimite
- Access to HIN event attendee’s list
- Profile Page on HIN platform
- Your Profile will be also be promoted on HIN's Social Media Channels
We are also giving you the opportunity to engage with our speakers, partners and delegates at our events, are you happy to share your details with them:

YesNo
I have read and accepted the terms and conditions:

By clicking here, you agree that the information provided in this form is complete and correct and you understand and accept the terms and conditions that make up this Agreement.
Should be Empty:

Virtual Networking Package - Monthly Membership Form