IntMeDA

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Company Name* This field is required.
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Company Address* This field is required.In case of different locations, fill the one you would like to be for invoicing purposes
Street Address
Street Address Line 2
City
Country
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
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Angola
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Mali
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Montenegro
Montserrat
Morocco
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Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
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Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
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Samoa
San Marino
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Syria
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Other
Country
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Company Website
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Main Contact Person* This field is required.
Mr.
Mr.
Mrs.
Prefix
First Name
Last Name
5
Email of Main Contact Person* This field is required.
example@example.com
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Phone Number of Main Contact Person* This field is required.(WhatsApp purposes)
Area Code
Phone Number
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Secondary Contact Person* This field is required.
Mr.
Mr.
Mrs.
Prefix
First Name
Last Name
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Email of Secondary Contact Person* This field is required.
example@example.com
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Phone Number of Secondary Contact Person* This field is required.(WhatsApp purposes)
Area Code
Phone Number
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Company is* This field is required.
Publicly traded
Privately held
Minority owned
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Number of Employees* This field is required.
1 - 5 Employees
6 - 20 Employees
21 - 100 Employees
Over 100 Employees
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Turnover range* This field is required.
≤ €2 million
≤ €10 million
≤ €50 million
> €50 million
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List of brands you represent* This field is required.Detailed description of the brands represented provides more precise portfolio additions when looking for various recommendations or business opportunities from IntMeDA members.
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Countries in which you are present.* This field is required.Detailed description of the markets you are present in provides more precise portfolio additions when looking for various recommendations or business opportunities from IntMeDA members. f.e. cardiology, radiology etc.
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Therapy areas (surgery devices, cardio, …)* This field is required.
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What are your expectations joining IntMeDA* This field is required.
Regulatory information
New business partners
Help with new market entry
New range of products for your business
More knowledge about medical industry
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How did you find IntMeDA* This field is required.
Recommendation of your partner
Web search
Network connection
Social media
PR material
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Please confirm your chosen membership tier:
Gold (990 EUR annually)
Silver (590 EUR annually)
Educational (290 EUR annually)
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Your first payment will consist of the annual subscription fee (based on your membesrhip tier) and the entry fee (390 EUR), which is payable in one lump sum.
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VAT Number* This field is required.(billing purposes)
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Personal data and logo processing consent* This field is required.
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Agreement to personal data processing
Stichting voor Internationale Medical Device Distributeurs with a seat at Hannie Schaft Straat 185, 2135 KD Hoofddorp, RSIN No.: 861176868, as the controller processes your personal data that you have completed on this application, for the purpose of managing ("IntMeDA ").
By ticking the appropriate field, you agree that IntMeDA will process your personal data to the extent [name, surname, title, company / medical facility, department, your position, e-mail address, telephone number] to send business communications concerning IntMeDA (International Medical Device Accelerator) activities, invitations to other educational events and congresses of IntMeDA [and the products, services and activities of its partners], to your e-mail.
Granting your consent is voluntary and your consent may be withdrawn at any time at the e-mail address [krystof.jelinek@intmeda.com], this shall not affect the lawfulness of processing based on consent before its withdrawal. You can also easily unsubscribe from our newsletters using the button provided in the footer of each e-mail.
We process your personal data for as long as necessary for managing IntMeDA and for the period specified by law. We process your personal data based on your consent unless you withdraw it.
You have the right (i) to access personal data, (ii) to correct inaccurate and complete incomplete personal data, (iii) to erase personal data if personal data are no longer necessary for the purposes for which they were collected or otherwise processed, or (iv) the restrict the processing of your personal data, (v) the portability of the data, and (vi) the right to object to the processing of your personal data, after which the processing of your personal data will be terminated, if the compelling legitimate grounds for the processing which override the interests, rights and freedoms of the data subject, namely for the establishment, exercise or defense of legal claims, are not demonstrated, (vii) the right to contact the supervisory authority to lodge a possible complaint.
[Intmeda's contact details: info@intmeda.com, +420 730 517 627].

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