MTQG Membership Registration Form

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Section 1 Application Details

Section 2 Fees & Membership

Until we are able to demonstrate the value that we can bring as an organisation, we will not be charging a fee to our members. There is no requirement to be a member of the CQI to participate in the MTQG, although we highly recommend that you consider membership. By completing this application you will be kept informed of any events sponsored by the MTQG and dates for Steering Committee Meetings.

Are you currently a member of the CQI?

Yes
No

Would you be interested in receiving additional information regarding membership of the CQI?

Yes
No

Are you interested in serving on the MTQG Steering Committee?

Yes
No

What topics would you like the MTQG to highlight in upcoming events?

In what activities do you think the MTQG should become involved?

Other comments:

Title
Family name
Personal Name
Addresses (please mark with an 'x' the address to be used for correspondence)
Business		Home
Name
Address		Address
Town		Town
County/State		County/State
Post Code		Post Code
Country		Country
Telephone		Telephone
E-mail		E-mail
(Note: Communication will be by e-mail.)
To enable us to design our events and services to best suit your needs or interests, please take a moment to complete the following questionnaire:
Main employer (please tick one of the following options):
Manufacturer R&D University Consultancy Contract Services Notified Body Government Agency Healthcare Other
Size of Organisation (please tick one of the following options):
1-10 employees 11-50 51-200 201-500 501 and above
Primary Responsibilities (please tick all options that apply):
Manufacturing Quality Assurance R&D Regulatory Affairs Clinical Affairs Engineering Management Other
Types of Products or Service (please tick all options that apply):
Active Implantable Device Anesthetic & Respiratory Devices Dental Devices Electromedical Devices Device/Drug Combinations Hospital Hardware In Vitro Diagnostics Ophthalmic and Optical Devices Non-active implants Reusable Instruments Technical Aids for Disabled Persons Single Use Devices Diagnostic & Therapeutic Radiation Devices Other
In which geographic areas does your company currently market or would have interest in marketing products? (please tick all options that apply):
Europe United States Canada Asia Commonwealth CIS Latin America Other