IP Affiliate Application AAHID IP Affiliate Application For more information, contact Angela Hare (Kermes), Industry Relations Manager at ahare@aahid.org. "*" indicates required fields InstagramThis field is for validation purposes and should be left unchanged.IP Affiliate Organization InformationCompany/Organization Name*Website* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Description*Business Type* Multi-Line Representative Distributor Dealer Other Healthcare Market Focus* Acute Care Ambulatory/Outpatient Behavioral Health Long-Term Care/Senior Living Other Other Business TypeOther Healthcare Market FocusPrimary Contact InformationPrimary Contact Name* First Last Title*Email* Phone*Secondary Contact (optional)Secondary Contact Name First Last TitleEmail Address Manufacturer RepresentationList of current AAHID Industry Partners Represented*Please list all current AAHID IPs that the company represents. Add RemoveProduct Categories Represented* Art & Accessories Associations & Organizations Bath & Restroom Ceiling Fabric, Textiles & Upholstery Flooring Furniture Headwalls & Wall Mounts Lighting Surfaces Wall Coverings Window Treatments Geographic CoveragePrimary Geographic Area(s) Served*Please list which States, Provinces, or Regions you represent. If there is National Coverage, please type "National Coverage".Company Logo*Please upload your company logo imageAccepted file types: jpg, gif, png, Max. file size: 2 MB. Acknowledgment* I confirm that our organization represents at least one manufacturer that is a current AAHID Industry Partner in good standing. I understand that AAHID recognition and promotional support apply only to those manufacturers that maintain active Industry Partner status. I also agree to comply with the AAHID IP Affiliate program guidelines and terms of participation.Signature*Type your first and last name above as your electronic signature.Date*AAHID IP Affiliate Annual Fee*Clicking the "Submit" button below will take you to a secure PayPal checkout to submit your payment. If you need an invoice to pay via check, please contact Angela Kermes, Industry Relations Manager, at akermes@aahid.org. Price:
