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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






We would like to keep you informed about events, activities, opportunities and news in the Life Sciences sector (*)


YES – I want to receive information regarding events, activities, opportunities and news in the Life Sciences sectorNO - I do not want to receive information regarding events, activities, opportunities and news in the Life Sciences sector

Main Contact Two






We would like to keep you informed about events, activities, opportunities and news in the Life Sciences sector (*)


YES – I want to receive information regarding events, activities, opportunities and news in the Life Sciences sectorNO - I do not want to receive information regarding events, activities, opportunities and news in the Life Sciences sector

Main Contact Three






We would like to keep you informed about events, activities, opportunities and news in the Life Sciences sector (*)


YES – I want to receive information regarding events, activities, opportunities and news in the Life Sciences sectorNO - I do not want to receive information regarding events, activities, opportunities and news in the Life Sciences sector

Main Contact Four






We would like to keep you informed about events, activities, opportunities and news in the Life Sciences sector (*)


YES – I want to receive information regarding events, activities, opportunities and news in the Life Sciences sectorNO - I do not want to receive information regarding events, activities, opportunities and news in the Life Sciences sector

Main Contact Five






We would like to keep you informed about events, activities, opportunities and news in the Life Sciences sector (*)


YES – I want to receive information regarding events, activities, opportunities and news in the Life Sciences sectorNO - I do not want to receive information regarding events, activities, opportunities and news in the Life Sciences sector