Corporate Online Application Form
Corporate Details
Company name
Company registration number
Postal address
Postal code
Physical address (Only one required)
Telephone number (Including area code)
Fax number (Including area code)
Email address to use for Association Notices
Website address (if any)
Company logo (For email or website linking. Please )
Use the logo from our web site as above
I will email the logo
Please provide us with a maximum of three descriptive sentences to be placed beside your CEASA website logo.
Clinical Engineering Employees
Does the company directly employ Clinical Engineering practitioners?
Yes
No
How many Clinical Engineering practitioners does the company directly employ?
Please provide us with the names of the Individual CEASA members whom are employed by the Company.
(At least 50% of all CEP's in your direct employ must be Individual CEASA members in good standing.)
Does the company use external Clinical Engineering contractors?
No
Yes
How many external Clinical Engineering contractors does the company employ?
Please provide us with the names of the external Clinical Engineering contractors.
Declaration and Administration
Name of person submitting this application
Cellular phone contact number
The company agrees to abide by the Constitution
Yes
No
Mandatory anti-spam question
You MUST answer this question correctly to submit
the form OR be prepared to re-do it all over again!
What is 9 + 3 = ? ? (A number is required)