Primary reason why you're joining the IMDMC?

• Please provide the primary contact information:

        First Name 
         Last Name 
             Title 
      Organization 
    Street Address 
   Address (cont.) 
              City 
    State/Province 
   Zip/Postal Code 
        Work Phone 
               FAX 
            E-mail 
               URL 
  

• Additional contact information 2 for IMDMC mailing list:

        First Name 
         Last Name 
             Title 
    Street Address 
   Address (cont.) 
              City 
    State/Province 
   Zip/Postal Code 
        Work Phone 
               FAX 
            E-mail 
  

• Additional contact information 3:

        First Name 
         Last Name 
             Title 
    Street Address 
   Address (cont.) 
              City 
    State/Province 
   Zip/Postal Code 
        Work Phone 
               FAX 
            E-mail 
  

• Please select the appropriate membership category*:

  Full Membership -  Designated for Indiana-based medical device establishments.  Full members receive reduced fees for all IMDMC activities and voting privileges.  Full membership dues are based upon annual sales revenue.  (Please check one)

      Less than $100 million in sales revenue = $700 dues

      $100 million - $1 billion in sales revenue = $900 dues

      More than $1 billion in sales revenue = $1,200 dues
  
  Affiliate Membership - Subtract $100 from the selected full membership category of the primary company member.  Designated exclusively for companies with a different name and/or location that are affiliated with a company that is a full member.  Affiliate members receive reduced fees for all IMDMC activities and are represented by votes cast by their full member company.  (Please check both the full membership category and the affiliate box)
  
  Associate Membership - $475  Designated for companies and individuals who provide products and services to the medical device industry; educational and research organizations; governmental units; and out-of-state medical device manufacturers.  Associate members receive reduced fees for all IMDMC activities.

  Startup Company - $300  Designated for medical device companies who have been in business for less than 3 years.  Startup company members receive reduced fees for all IMDMC activities.

  Government Employees - $300  Designated for employees of any level of government.  Government employee members receive reduced fees for all IMDMC activities.

  
  

  **IMDMC member dues are not tax deductible due to our federal advocacy efforts on behalf of the membership.