Device Manufacturer Sign-up Form

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To sign up as a manufacturer on Med Device Network, please fill out the following

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 *

North America

Europe

Asia

South America

Middle East

Australia

Africa

Required

Which of the following medical devices does your company manufacture? *

Ventilators

Dialysis Machines

Pulse Oximeters

Other:

Required

Is the device your company manufactures approved for use in the intended jurisdiction you intend to sell in? *

Yes, 510(k) or PMA approval from FDA

Yes, approval from a regulatory body other than the FDA

No, 510(k) or PMA submitted, FDA response pending

No, application submitted to a regulatory body other than the FDA

No, application has not been submitted to any regulatory body

Other:

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) *

Sourcing components

Supply logistics

Scaling manufacturing

Distribution

Distribution logistics

Ancillary PPE

Design updates

Logistics (other)

Other:

Required

Is your company a member of Advamed? *

Yes

Is your company a member of the Aerospace Industries Association? *

Yes

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

Yes, I have read and agree to the NDA

Required

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

Yes, I have read and agree to the 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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