Registration Organization

Company:*

Parent Company (if applicable):

URL:

Registered Health Care Authority:

If a US FDA Finished Device Manufacturer, provide registration number:

If the Company manufactures an orthopedic product that may still be in development or in clinical trials, please describe the status:

Has the company previously held membership in Orthopaedic Surgical Manufacturers Association (OSMA)?

Yes

If yes, state the reason for withdrawal and/or termination of OSMA membership:

If as an OSMA member, the company membership lapsed due to not maintaining its annual dues, the Company shall not be eligible for membership until such past dues are paid. If the membership was terminated, the Company shall not be eligible until it has passed the termination period and, if applicable, remedied the issue causing termination.

Primary Representative (Designated Voting Member):

Name*

Title*

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Email Address

Secondary Representative:

Name*

Title*

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Email Address

Member Profile: (briefly describe your company and interest in OSMA membership or attach a statement on your company letterhead)

Annual membership dues are assessed on the company’s Global Gross Annual Sales as shown in the table below. A company with multiple divisions should determine which employees will be participating and assess the sales based on which divisions will participate with OSMA. The applicant must specify which divisions are being represented.

Annual dues will be pro-rated based on the quarter the company is accepted for membership, i.e. the company is accepted on May 15, dues will be pro-rated for three (3) quarters.

Please check the box that describes the company’s global gross annual sales.

Global Gross Annual Sales

Over $1 billion - Dues $11,000

$750 - $1 billion - Dues $10,500

$500 - $750 million - Dues $10,000

$300 - $500 million - Dues $8,500

$100 - $300 million - Dues $8,000

$50 - $100 million - Dues $3,500

$5 - $50 million - Dues $2,000

Less than $5 million - Dues $1,500

Specify which divisions are represented, if applicable:

Upon acceptance of membership, the company agrees to adhere to the Antitrust Guidelines and Membership Responsibilities (previously supplied) of the Orthopaedic Surgical Manufacturers Association.

By:

Title:

Date:

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Phone

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Sign up as New Organization

Fill out the form below to get started on your OSMA membership as Organization.

Primary Representative (Designated Voting Member):

Secondary Representative:

Please check the box that describes the company’s global gross annual sales.

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