MEDILINK EAST MIDLANDS

+44 (0) 115 912 4330

info@medilinkem.com

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Online Membership Form



Please note: This form cannot be saved so please ensure you have all the necessary information available to complete the registration.

Company Information

Company / Organisation Name

Department / Group

Address




Post Code

Contact Number

Email Address

Website

Description of Business Activity
Max 25 words:

Number of Employees
I confirm that by completing this form, I agree that our organisation will become a member of Medilink East Midlands at the applicable annual rate as indicated below.

Category Rate
Start-up* £135 + VAT
1 - 5 Employees £330 + VAT
6 - 19 Employees £425 + VAT
20 – 49 Employees £550 + VAT
50 - 249 Employees £695 + VAT
250 + Employees £835 + VAT
Associate £175 + VAT

*1st year of establishment

You will be invoiced once the form has been received by Medilink East Midlands.

Person completing the form:

First Name:

Last Name:

Position:

Email Address:

Telephone:

Date:

Main Contacts’ Details: (please provide the details for all of those in your organisation who would like to receive our e-newsletter)

Important: You must add at least one contact. To do this, complete the four boxes below and click 'Add contact'.


First Name:

Last Name:

Position:

Email Address:

Telephone:

Add Contact

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