IntMeDA

IntMeDA Membership Registration Form
Company Name*
Company Address*

Street Address

Street Address Line 2

CityCountry

Postal / Zip Code
Company Website*
Main Contact Person*

PrefixFirst NameLast Name
Email of Main Contact Person*
example@example.com
Birthdate Of Contact Person*

YearMonthDay
Date
Phone Number of Main Contact Person*

Area CodePhone Number
Company is*

Publicly tradedPrivately heldMinority owned
Number of Employees*
Turnover range*
Therapy areas (surgery devices, cardiology, anaesthesia etc.)*
List of brands you represent (Manufacturers/Suppliers)*
Detailed description of the brands represented provides more precise portfolio overview when looking for various recommendations or business opportunities for IntMeDA members.
Countries in which you are present.*
Please type the emails of all the colleagues you'd like to include in IntMeDA events, activities and communicational channels.*
What are your expectations joining IntMeDA

Regulatory informationNew business partnersHelp with new market entryNew range of products for your businessMore knowledge about medical industryOther
How did you find IntMeDA

Recommendation of your partnerWebsiteNetwork connectionLinkedInPR materialOther
Please confirm your chosen membership tier:*

Gold (1090 EUR annually)Silver (890 EUR annually)Educational (790 EUR annually)
Your first payment will consist of the annual subscription fee (based on your membership tier) and the entry fee of € 490, which is payable in one lump sum.
VAT Number (If applicable)
Member Referral
Enter any questions or comments you may have
Should be Empty:

IntMeDA Membership Registration Form