IMDRF Working Group - Membership Application Form - Contact Details for Applicant - Medical devices

What is your name?

Title

Name

What is your Job Title?

Job Title

What is your organisation?

Organisation

What is your email address?

Email

What is your phone number?

Phone number, including country code

Is your organization a regulatory authority?

(Required) Yes No

Are you part of an organization which is NOT a regulatory authority?

(Required) Yes No

To which of the IMDRF Working Groups are you nominating your appointed expert?

(Required) Adverse Event Terminology Artificial Intelligence/Machine Learning-enabled Clinical Evidence for In Vitro Diagnostic Medical Devices Good Regulatory Review Practices Personalized Medical Devices Quality Management Systems Regulated Product Submission Software as a Medical Device Medical Device Cybersecurity Guide (Not current)

Name of nominated individual:

Title

Name

Has your organisation applied to other IMDRF Working Groups?

(Required) Yes No