City/ Post Code: Principal Contact’s Information Representative Title: Name: Tel: ( ) Fax: ( ) Email: Activities Undertaken by your Organisation What are the principal activities of your organisation in Australia? Please check all that apply Biotechnology interests Non-PBS pharmaceuticals (private prescription Capsule manufacturer products) Consultancy services (Market research) Non-prescription pharmaceuticals Contract manufacturer Orphan drug sponsors Contract regulatory services Packaging Contract Research Organisation (CRO) PBS listed pharmaceuticals Distributor/Wholesaler Prescription product manufacturing Drug delivery technologies Prescription product marketing eheathcare (Internet based healthcare) Research and development (R&D) Generic pharmaceuticals manufacturer/supplier Toll manufacturing Licensed pharmaceutical raw material manufacturer () Other If relevant, what are the principal activities of your parent organisation internationally? Is the Annual Report of your organisation Yes or that of your parent enclosed with your No application? Statement of claim for membership Please provide a statement explaining why your organisation is seeking membership of Medicines Australia.
City/ Post Code: Principal Contact’s Information Representative Name: Title: Tel: ( ) Fax: ( ) Email: Activities Undertaken by your Organisation What are the principal activities of your organisation in Australia? Please check all that apply Biotechnology interests Capsule manufacturer Consultancy services (Market research) Contract manufacturer Contract regulatory services Contract Research Organisation (CRO) Distributor/Wholesaler Drug delivery technologies eheathcare (Internet based healthcare) Generic pharmaceuticals manufacturer/supplier Licensed pharmaceutical raw material manufacturer () Non-PBS pharmaceuticals (private prescription products) Non-prescription pharmaceuticals Orphan drug sponsors Packaging PBS listed pharmaceuticals Prescription product manufacturing Prescription product marketing Research and development (R&D) Toll manufacturing Other If relevant, what are the principal activities of your parent organisation internationally? Is the Annual Report of your organisation or that of your parent enclosed with your application? Yes No Statement of claim for membership Please provide a statement explaining why your organisation is seeking membership of Medicines Australia.