European Medical Device Manufacturer
  European Medical Device Manufacturer is free to qualified professionals. Summary Description
  To apply for a FREE subscription to European Medical Device Manufacturer, please answer ALL of the questions on the form below.
  The publisher determines qualification and reserves the right to limit the number of free subscriptions.
  Geographic Eligibility: Europe


 
1. Do you wish to receive a FREE subscription to European Medical Device Manufacturer?
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First Name:
Last Name:
Job Title:
(Ex: Director, Vice President, Project Manager, etc.)
Company:
(Please provide your Company Name in full: abbreviations could disqualify you)
Address:
Dept./Div.:
City:
Postal Code:
Country:
(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Phone:
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Email:
(Note: Valid email address is required or you could be disqualified.)
 
Yes, please auto-fill my contact information for other publication qualification forms.


2. Please tick the category that best describes your company. (select only one)
Manufacturer of Finished Medical Devices Provider of Subcontracting Services
Manufacturer of In Vitro Diagnostics Manufacturing Consultant
Manufacturer of Dental Implants, Instruments and Systems Government/Academic
Manufacturer of Pharmaceuticals Others Allied to the Field (please specify)


3. Please tick the category that best describes your job function. (select only one)
Product Design Engineering (including Product Design Engineering management)
Project Engineering (including Project Engineering Management)
Research and Development
Production/Manufacturing (including Production/Manufacturing Management)
Process Engineering (including Process Engineering Management)
Procurement/Specifying/Materials Management/Inventory Control
Quality Assurance/Quality Control
Regulatory/Legal Affairs
General/Corporate Management
Consultant
Other (please specify)


4. How many employees in your company? (select only one)
1-24 100-249
25-99 250+


5. Which of the following products do you recommend, specify, or purchase? (select all that apply)
Components/Products Manufacturing Services
Disposables (inc catheters, pumps, seals, syringes, connectors, guide wires) Assembly
Dental Products Full Service Manufacturing
Diagnostic Kit Components Electronics Manufacturing Services
Metal Parts Metal Fabrication
  Plastics Forming (inc moulding & extrusion)
Consulting  
Regulatory Materials
Manufacturing Plastics
Business Development Ceramics
Translation Services Metals
  Adhesives
Computing Coatings
Embedded Systems Films
Software  
  Packaging
Design and Research and Development Services Packaging Equipment
Design Engineering Packaging Materials
Electrical Systems/Subassemblies Packaging Services
Product Design and Development  
Prototyping/Rapid Prototyping Printing/Bar Coding
  Printing/Bar Coding Equipment
Electrical and Electronic Components Printing/Bar Coding Materials
Cables and Connectors Printing/Bar Coding Service
Motors  
Power Supplies/Batteries Sterilisation
Sensors & Switches Sterilisation Equipment
  Sterilisation Services
Filters  
  Testing
Manufacturing Equipment Testing Equipment
Adhesive-Curing Equipment Testing Services
Assembly Systems  
Automation Systems Tubing
Converting Equipment Metal
Metal Fabrication Plastic
Plastics Processing (inc moulding & extrusion) Tubing Equipment
 
Other (please specify)


6. In order to verify your request for this subscription without the availability of your signature, Canon Communications' audit bureau requires that they ask a personal identifying question. This information is used SOLELY for the purpose of auditing your request. What is the day of your birth?


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To permit future verification of your request, please answer ONE of the following questions:
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Which of the following BEST describes the primary business of your organization or division? (select only one)
A. HEALTHCARE PLAN, PAYOR & ADMINISTRATIVE ORGANIZATIONS:
HMO/PPO/PSO/Insurance Company
Medicare/Medicaid/Governmental Plan
Supplemental/Carve-Out Insurance Plan (Dental/Vision/Behavioral Health)
Pharmacy Benefits Management (PBM) including Medicare Part D PDP
Third Party Administration (TPA)
Utilization Review Firm
Contract Management Firm
Group Purchasing Organization (GPO)
Employee Benefits Management (EBM) Firm/Consultant
Other Healthcare Plan, Payor & Administrative Organization
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B. HEALTHCARE PROVIDER ORGANIZATIONS: (An entity that directly treats patients)
Integrated Health Organization (IHO) (multi-hospital/practice settings; same ownership)
Integrated Delivery System (IDS) (multiple practice settings; same ownership)
Integrated Health Network (IHN) (multi-hospital; separate ownership)
Multi & Large Group Practice (50+ physicians)
Multi & Large Group Practice (less than 50 physicians)
Independent Hospital (300+ beds)
Independent Hospital (less than 300 beds)
Independent Practice Association (IPA)
Medical Clinic (50+ physicians)
Medical Clinic (less than 50 physicians)
Long-term Care Facility or Multi-Facility
Home Healthcare Organization
Other Healthcare Provider Organization
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D. NON-HEALTHCARE EMPLOYERS OF: (Aerospace, Automotive, Banking/Financing, Construction, Consumer Goods, Energy, Federal & State Government, Food/Grocery, IT–Hardware & Software, Retail)
5,000+ Employees
1,000 - 4,999 Employees
200-999 Employees
E. OTHER
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Which of the following titles & specialties BEST describes your highest current management position in the business organization selected in the above question? (select only one)
NON-CLINICAL EXECUTIVE:
Chief Executive: CEO/COO/President/Executive Director/Owner/Principal/VP/Director
Managed Care Executive: Chief/VP/Director
Administrative Executive: VP/Director
Financial Executive/Contracting Executive/Industry Relations Executive: CFO/VP/Director/Treasurer/Controller
Information Technology & Intelligence Services Executive: CIO/VP/Director (Software, Hardware, Web, Data Processing, Technology Assessment)
Medical Records Executive: VP/Director
Marketing Executive: CMO/VP/Director
Sales Executive: CSO/VP/Director
Patient Relations/Member Services Executive: VP/Director
Human Resources Executive: VP/Director
Employee Benefits Executive: VP/Director
Legal/Regulatory/Affairs Executive: Chief Counsel/VP/Director
Risk Management Executive: VP/Director
Other Non-Clinical Executive: VP/Director
Please specify for Other:
CLINICAL EXECUTIVE:
Medical Director
Chief of Medicine/Chief of Staff
VP/Director/Chief of Medical Affairs
Clinical Program Director/Services VP/Director (Specify: e.g., Oncology, Sports Medicine, Transplant, Disease, ER, Trauma, Wellness, Physical Therapy, Radiology, etc.)
Please specify:
Pharmacy/Formulary Director/Formulary Committee Chair
VP/Director/Chief of Pharmacy Services
Drug Information Officer/Clinical Pharmacist
VP/Director of Nursing/Chief of Nursing Affairs
Utilization Review/Quality Assurance VP/Director
Case Management VP/Director
Provider Relations VP/Director
Other Clinical Executive: VP/Director
Please specify for Other:
  Are you currently a P & T Committee member/presenter/contributor? Yes     No
  Total number of lives covered if at a Managed Care Plan/Payor Organization:
  Do you presently play a role in Pharmacy Benefits Design/Structure, Drug Choice and/or Implementation? Yes     No
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Copyright © 2009 European Medical Device Manufacturer, All Rights Reserved.