MEMBERSHIP APPLICATION FORM

Private Listed Company Application

Company Name ABN

or Subsidiary Company Application

Subsidiary Name

Street*

Suburb*

State*

Post Code*

Postal Address*

Phone*

Email*

Fax

Contacts

Company Contact*

Company Director*

Company GM*

Business Information

Business Focus* Cardiac
General
Ophthalmology
Orthopaedics
Spinal
Neurology
Urology

Turnover* $1-2 million
$2-5 million
$5-15 million
$15+ million

Staff* 1-3
4-10
11-20
21+

Authorised Representative

Name*

Position*

Contact Phone*

Email*

By ticking below box I declare that I am the authorised representative of the abovementioned company and apply for membership to the AMMDA INC Australian Medical Manufacturers & Distributors Association Inc.

All Employees of the abovementioned company will abide by the AMMDA INC guidelines and the AMMDA INC Code of Conduct.

I agree with the above declaration*

Date*

Subsidiary Company Application

Thank you for your application to become a member of AMMDA.

Once we have approved your application and payment has been made we will confirm your membership.

About AMMDA

The AMMDA is committed to being a voice of our members ensuring that all med tech community is heard; from sole traders to Multi-nationals.

The AMMDA will focus on being not just the voice, but also the eyes and ears for its members regarding changes in the regulatory, reimbursement and any others that impacts on our ability to innovate, manufacture and supply to the Australian market.

Contact Details

Mon - Fri

08:00 - 17:00

Phone

1300822288

Fax

+61 7 326 29851

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