FILL OUT THIS APPLICATION TO GET YOUR HEALTH BUSINESS LISTED ON THE HEALTH BIZ HUB

Step 1: Company Information

First Name *

Last Name *

Email *

Phone *

Company Name *

Website *

Step 2: Business Details

Briefly describe your business and the products or services you offer. *

How long has your company been in business? *

What are your primary target markets or customer demographics? *

Step 3: Affiliate Partnership

Are you open to a Two-Tier affiliate relationship where Mindshare earns a commission on sales made through our platform? *

Yes

No

Don't have one

Are you interested in being an exhibitor at the Health Biz Growth Summit?

Yes

No

Maybe

Any additional comments or questions? *

NEXT