Device Manufacturer Sign-up Form
To sign up as a manufacturer on Med Device Network, please fill out the following
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Your Name *
Please enter your First and Last name without initials
Company Name *
Please enter the name of your company or organization
Corporate Email Address *
Please enter your corporate email address where you can be reached
Phone Number *
Please enter your phone number including area code and/or country code (numbers only - no dashes or spaces)
What is your role within your organization? *
Please add email addresses (comma-separated) for other individuals at your company who will need access
Your company location *
Required
Which of the following medical devices does your company manufacture? *
Required
Is the device your company manufactures approved for use in the intended jurisdiction you intend to sell in? *
What is your company's current production rate for the product with which you need help (units/week) *
To increase production, our company needs help with the following? (select all that apply) *
Required
Is your company a member of Advamed? *
Is your company a member of the Aerospace Industries Association? *
Nondisclosure Agreement (NDA) *
By checking this box, I certify that I have read and agree to the following NDA: https://sites.google.com/ventconnect.org/ventconnect/NDA
Required
Terms of Use *
By checking this box, I certify that I have read and agree to the following Terms of Use: https://sites.google.com/ventconnect.org/ventconnect/terms-of-use
Required
SiliconExpert (an electronic component data solutions provider) is offering full access to their analytics tools and database of over one billion parts and thousands of suppliers. Your access will remain in force for 90 days or as long as the need for ventilators continues.
For more info and to sign up, please visit https://www.siliconexpert.com/MedDeviceNetwork
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