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Registration Form 2019

You are here: Home » EQA Programme » EQA Registration » Registration Form 2019

ECAT REGISTRATION FORM 2019

Instructions Please complete and submit this Registration Form 2019 if you want to register for our programme. Only use this form if you are a new participant in our programme.
After submission you will receive a confirmation by e-mail. Prices can be found on the website. If you need any assistance, please contact us at info@ecat.nl.

Annual subscription fee

Select one of these options:
Annual subscription (mandatory for each participant) *
Results submission via internet / survey report as pdf on websiteResults submission via internet / survey report as pdf on website and as print by postal service

ECAT Modules 2019

Instructions Please select the modules you want to subscribe for in one of the boxes below:

Main Programme

[402] Thrombophilia - I (Antithrombin, Protein C and Protein S)[417] Thrombophilia - II (APC Resistance)[404] Lupus Anticoagulant / Antiphospholipid Antibodies[406] Coagulation Factor - I (Factor VIII, IX, XI and XII)[407] Coagulation Factor - II (Factor II, V, VII and X)[408] von Willebrand Factor parameters[409] ADAMTS13 - I (activity and antigen)[410] ADAMTS13 - II (antibodies)[411] Factor XIII (activity and antigen)[412] Fibrinolysis - I (Plasminogen, Antiplasmin)[413] Fibrinolysis - II (t-PA antigen, PAI-1 activity and antigen)[202] Factor VIII Inhibitor[201] Factor IX Inhibitor[203] Thrombin Generation test[204] HIT - I (Immunological testing)[414] Unfractionated Heparin Monitoring (anti-Xa)[415] Low-Molecular Weight Heparin Monitoring (anti-Xa)[205] Orgaran[206] Fondaparinux[207] Rivaroxaban[208] Apixaban[221] Edoxaban[209] Argatroban[210] Dabigatran[416] Homocysteine

ROTEM/TEG Programme

[212] ROTEM delta; 1 instrument/ 1 set of samples[213] ROTEM delta; 2 instruments/ 2 sets of samples[214] ROTEM delta; 3 instruments/ 3 sets of samples[215] ROTEM sigma; 1 instrument/ 1 set of samples[216] ROTEM sigma; 2 instruments/ 2 sets of samples[217] ROTEM sigma; 3 instruments/ 3 sets of samples[218] TEG; 1 instrument1/ 1 set of samples[219] TEG; 2 instruments/ 2 sets of samples[220] TEG; 3 instruments/ 3 sets of samples

D-Dimer Programme

[405] D-Dimer

Screen Programme

[501] Screen - I (APTT, PT/INR, and Fibrinogen)[502] Screen - II (Thrombin Time, Reptilase Time)

POCT INR QC Programme

[301] POCT INR QC Programme for CoaguChek (any type)

Other surveys

[701] Post Analytical Platelet Function EQA (2 surveys per year)[704] Platelet Dense Granule exercise (2 surveys per year)[703] Case studies on bleeding disorders (2 surveys per year)[705] Pre- and post-analytical surveys in haemostasis (1 survey per year)

Molecular Biology

(in co-operation with the DGKL, Germany)
Molecular Genetics MG1
[601] Molecular Genetics MG1 Set A[602] Molecular Genetics MG1 Set B[603] Molecular Genetics MG1 Set C[604] Molecular Genetics MG1 Set D[605] Molecular Genetics MG1 Set E[606] Molecular Genetics MG1 Set F
Molecular Genetics MG2
[801] Molecular Genetics MG2 Set A[802] Molecular Genetics MG2 Set B[803] Molecular Genetics MG2 Set C[804] Molecular Genetics MG2 Set D[805] Molecular Genetics MG2 Set E[806] Molecular Genetics MG2 Set F
Other modules
[901] DNA Sequencing[902] DNA Isolation

Extra sets of samples

For the modules of our MAIN, D-DIMER and SCREEN programme we provide extra sets of samples.
The price of an extra set is 70% of the regular module price. An extra set contains the same number of vials as the original set (single vials can not be ordered).
Please indicate for which module(s) you want to order extra sets and how many extra sets you want:
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Contact Information

Responsible person The completion of the fields of the responsible person are mandatory. The other categories are optional and only have to be completed if they differ from the contact details of the responsible person.
Other contact persons If you want to add other contact persons, please select the options at the end of this page and complete the fields. If you don't want to add extra contact details, please select the option "Always use the contact details of the responsible person".
Submission of Registration Form On the last page you can add financial information and submit the Registration Form to our office. You will receive a copy of your registration by e-mail.
Contact information of Responsible person:
Title
First name *
Surname *
Hospital / Institute *
Department / Laboratory
Street *
Zip code *
Town / City *
State
Country *
Phone *
Email *
Use different contact details for *
Sample person: receives samplesReport person: receives printed reports (pdf available on website)Invoice: receives invoiceAlways use the contact details of the responsible person

Sample Person

Title

First name *

Surname *

Hospital / Institute *

Department / Laboratory

Street *

ZIP code *

Town / City *

State

Country *

Phone *

Email *

Contact details "Report":

Title

First name *

Surname *

Hospital / Institute *

Department / Laboratory

Street *

ZIP code *

Town / City *

State

Country *

Phone *

Email *

Contact details "Invoice":

Title

First name *

Surname *

Hospital / Institute *

Department / Laboratory

Street *

ZIP code *

Town / City *

State

Country *

Phone *

Email *

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Other information:

Order number (optional, enter the order number of your financial administration)
VAT number (if VAT number not available enter N.A.)
VAT under which name registered
Terms of delivery *
I agree with the general terms of delivery and services of the ECAT Foundation (Available at the ECAT website item Terms and delivery)
Accreditation *
Is your laboratory accredited?YesNo
Accreditation standard (e.g. ISO 15189) If your laboratory is accredited, please indicate the standard here.
Email *Please enter the e-mail addres for the confirmation.
Comments
If you have any remarks or if you want to add additional information, please use the box below.

Verification

Please enter a number: *For instance: 12
This box is for spam protection - please leave it blank

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Mission and Vision
EQA Programme Manual
EQA Programme and prices 2023
EQA Survey Schedule 2023
EQA Registration
Assay Evaluation Project BAY94-9027
Accreditation
Terms of Delivery

ECAT Foundation | P.O. Box 107 | 2250 AC Voorschoten | The Netherlands | Email: info@ecat.nl | T: +31 (0) 71 3030 910 | F: +31 (0) 71 3030 919

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