IFPW Membership Application
Click here to view the 2016 Dues Schedule

Organization Name:
        Acronym (if any):

Address:
Street: 
City: 
State/Province: 

Zip/Postal Code:

Country:
Telephone:

Fax:

General Email:
Website:

 

 .......... 

Association

A national distributor's organization.  For countries that have no national trade association, the pharmaceutical distributor doing in excess of 50% of the wholesale trade may be considered an association member.
Membership Type:

Manufacturer

Suppliers of ethical pharmaceutical and proprietary medicines and producers of other products distributed by pharmaceutical wholesalers.
   

Service

Organization 

  Firms that provide a service, product or value to distributors for the distributors' internal use.
   

Wholesaler /

Distributor

  Individual wholesale firms that participate in IFPW in addition to their own national association.
Executive Listing:

Chief Executive Officer

Email

Chief Operating Officer Email

Contact for IFPW

Email


Geographic Region(s) in which Organization Conducts Business
Asia / Australia      % of Annual Sales
Europe / Middle East / Africa             % of Annual Sales
Latin America   % of Annual Sales
United States / Canada    % of Annual Sales

Organization Information
Date Established Number of Employees:
Annual Sales in US$    
Number of Customers Largest Customer Market:

Non-wholesalers, skip to next section:

Number of Distribution Centers
Percentage of Sales in Pharmaceuticals
Type of Pharmaceuticals Sold

Personal Information
Your Name
Your Position