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Online Membership Form

To become a member, please complete the form below.

Company Information











Choose a Membership Type

*Life Science organisations (or business units of larger companies)
**For non-Life Science organisations

I confirm that by completing this form, I agree that our organisation will become a member of Medilink East Midlands.

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

Person Completing This Form






Main Contacts’ Details:



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

Number of those wanting to receive our Newsletter:

Main Contact One




Main Contact Two




Main Contact Three




Main Contact Four




Main Contact Five