Charitable Application

surgeon with device
  • Please Specify:
  • •The funds will be used only for the intended purpose of this request and will not be used in violation of any State or Federal Laws.

    •This request was not made with the intention or possibility to influence or improperly benefit an official to appear more favorable.

    • No Globus employee implicitly or explicitly offered a contribution to induce the Recipient, its personnel, or me to purchase, use, order, or recommend Globus products or to reward prior purchases, uses, orders, or recommendations of Globus products.

    • All information included on and documentation attached to this request form by the Requestor and/or Recipient is accurate.