** Please complete the required information as soon as possible to ensure a SmartDrive & the attachment hardware for your wheelchair will be available at the conference. **

Information & Agreement

MAX Mobility, now a part of the Permobil family, is pleased to offer manual wheelchair users attending ISS the loan of a SmartDrive MX2+ PushTracker during these conference days. A limited number of devices will be available on a first-come first-served offering.

You will be able to pick up and drop off a SmartDrive at the Permobil exhibit location at this event.

If you have any questions, concerns or issues please give us a call at +1 (615) 953-5350 / toll-free +1 (800) 637-2980 or e-mail sales@max-mobility.com.

User *
Phone *
Alternate Contact *
Alternate Contact
Alternate Contact Phone *
Alternate Contact Phone
Rear Wheel Size *
Frame Type *
In accepting the loan of this equipment, you agree to the following conditions: *
I understand a SmartDrive is being loaned to me for my personal use during the ISS conference exhibit hours. I will read and follow all the user / safety instructions for the SmartDrive, which can be viewed prior to the exhibit on the DEVICE INFO page. I will pick-up my SmartDrive from the Permobil exhibit and return the device before exhibits close on Friday. I will not take the SmartDrive out of the hotel at any time. I will ensure the SmartDrive I borrow will be cared for so that the product will be in NEW condition when I return it to the Permobil exhibit. I understand I am accepting responsibility for this device while in my care, valued at $7,131 USD. I will not leave the SmartDrive unattended at any time. I understand that I am using the SmartDrive at my own risk.