Sign up for a membership

Which membership would you like to apply for?
FullAssociate

General company and contact information

Company

Company name*

Company address*

Company phone*

Company e-mail*

Company website*

President, Managing director or equivalent

President name*

President phone*

President e-mail*

if different: Person responsible for Authorised Representative services

Representative name

Representative title

Representative phone

Representative e-mail

Company structure and organisation

Legal form*

Number of employees*

VAT and commercial reg no.*

Subsidiary of / independent*

Please tell us more about your activities as Authorised Representative.

Number of persons involved in authorised representative activities

Activities of authorised representative in the medical device field for at least 3 years?*
YesNo

Are you working for at least 10 medical devices manufacturers as their European authorised representative?*
YesNo

Are you a registered legal entity?*
YesNo

Do you have available at least one staff member with more than 4 years of regulatory experience in the field of medical devices?*
YesNo

Do you have available at least one permanent staff member with a degree in law, medicine, pharmacy, engineering or other relevant scientific discipline?*
YesNo

Is your authorised representative activity covered by liability insurance?*
YesNo

Have you notified your relevant Competent Authority about your authorised representative activities?*
YesNo

Further activities

What further services do you provide?*
Distribution/marketingRegulatory consultingQuality systems/auditingClinical investigation servicesReimbursement consulting

If you provide other services, please specify them. Otherwise, type "No".*

More information

How did you learn about EAAR?*

What are your motives for participating in EAAR?*

What do you wish to achieve by participating in EAAR?*

Comments

Would you like to add anything?

Signature

By submitting this form, I certify that the above information is complete and accurate and that the financial situation of the company identified under question is sufficient to warrant uninterrupted authorised representative services to customers for the foreseeable future. I allow a neutral agent to verify any information represented above, without divulging Company confidential information to EEAR. I understand that if I provide false or misleading information, the membership of my Company in EAAR may be terminated immediately upon discovery of this fact. If accepted as a member I and my company agree to act in accordance with the EAAR Code of Conduct and comply with the Articles of Association of the EAAR.

I have read and agree with the Code of Conduct

Name, title, date and place*

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