ORTHOCON is seeking medical sales representatives to sell its portfolio of next generation resorbable therapeutic devices to cardiac, spine, CMF, neuro, ortho, and trauma surgical specialties. The medical sales representative would join ORTHOCON as a sales consultant (1099) and will be free to sell one or all of ORTHOCON's products and non-competitive products manufactured by other organizations.

ORTHOCON is a high-growth venture capital-financed company founded by Richard L. Kronenthal, Ph.D., former head of R&D at ETHICON where he developed several market-leading products during his 32-year tenure.

ORTHOCON develops, manufactures, markets, and sells a portfolio of next generation resorbable therapeutic device products. In 2011, ORTHOCON announced the commercial introduction of its first 510(k) cleared product, HEMASORB Resorbable Hemostatic Bone Putty, and 510(k) clearance of HEMASORB Apply, a proprietary applicator designed to deliver HEMASORB and other ORTHOCON products presently under development. Over the next few years, ORTHOCON expects to introduce new products to the market for both bone and soft tissue applications.

For more information please visit our website at www.orthocon.com or contact us by email at sell-hemasorb@orthocon.com. Read our Privacy Statement

	First	Last
Name:*
Email Address:*
Phone Number:
City:*
State:*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:*
Do you currently sell surgical devices to cardiac, vascular, craniomaxillofacial, or orthopedic spine surgeons in surgery/hospitals? Yes    No
If yes, which one is your primary call-point? -- Select One -- Spine Cardiac CMF Other
Do you currently sell into procedures where bone bleeding occurs? Yes    No
If so, which types of products are used to achieve hemostasis? -- Select One -- Bone Wax Gelfoam/Thrombin Combination Other
Do you currently sell any of the following products? If so, please list the product:
		Name of Product
Bone Hemostat:
Bone Void Filler:
DBM:
Bone Cement:
Soft Tissue Hemostat:
Surgical Sealant:
Spinal Implants:
Surgical Plates, Screws:
Other:
Please list up to five hospitals you would like to sell to in order of highest to lowest preference:
	Name	City State Zip Code
Hospital 1:*		AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Number of years you have sold at this account:
Number of products you have gotten approved for sale:
Hospital 2:		AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Number of years you have sold at this account:
Number of products you have gotten approved for sale:
Hospital 3:		AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Number of years you have sold at this account:
Number of products you have gotten approved for sale:
Hospital 4:		AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Number of years you have sold at this account:
Number of products you have gotten approved for sale:
Hospital 5:		AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Number of years you have sold at this account:
Number of products you have gotten approved for sale:
Please provide the email addresses of anyone you may feel would be interested in participating as well:
Email 1:
Email 2:
Email 3:
Email 4:
Email 5:
Please check this box if you were referred by an existing Hemasorb Distributor:
	Distributor Name	Representative
Distributor:*