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ECAT registration form 2023
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ECAT registration form 2023
Registration form 2023
ECAT REGISTRATION FORM 2023
Instructions
Please complete and submit this Registration Form 2023 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
Mandatory for each participant
*
Annual subscription fee
ECAT Modules 2023
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)
[406] Coagulation Factor - I (Factor VIII, IX, XI:C and XII:C)
[407] Coagulation Factor - II (Factor II:C, V:C, VII:C and X:C)
[408] Von Willebrand Factor parameters
[409] ADAMTS13 - I (activity and antigen)
[410] ADAMTS13 - II (antibodies)
[419] ADAMTS13 - III (Functional inhibitor)
[411] Factor XIII (activity and antigen)
[412] Fibrinolysis - I (Plasminogen, Antiplasmin)
[413] Fibrinolysis - II (t-PA, PAI-1)
Lupus Programme
[404] Lupus Anicoagulant / Antiphospholipid Antibodies
D-Dimer Programme
[405] D-Dimer
Screen Programme
[501] Screen - I (APTT, PT/INR, and Fibrinogen)
[502] Screen - II (Thrombin Time, Reptilase Time)
APTT / PT Mixing Test Programme
[503] APTT / PT Mixing Test
Haemophilia Programme
[418] Haemophilia (Factor VIII, Factor IX [clot and chromogenic activity])
[202] Factor VIII Inhibitor
[201] Factor IX Inhibitor
[223] Emicizumab
[227] Kogenate FS (Bayer)
[228] Kovaltry (Bayer)
[229] Jivi (Bayer)
Anticoagulation Programme
[414] Unfractionated Heparin Monitoring (anti-Xa)
[415] Low-Molecular Weight Heparin Monitoring (anti-Xa)
[205] Orgaran (anti-Xa)
[206] Fondaparinux (anti-Xa)
[207] Rivaroxaban (anti-Xa)
[208] Apixaban (anti-Xa)
[221] Edoxaban (anti-Xa)
[209] Argatroban (anti-IIa/dTT)
[210] Dabigatran (anti-IIa/dTT)
Thromboelastography 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
[224] CLOT-PRO; 1 instruments/ 1 sets of samples
[225] CLOT-PRO; 2 instruments/ 2 sets of samples
[226] CLOT-PRO; 3 instruments/ 3 sets of samples
Thrombin Generation Programme
[203] Thrombin Generation test
PFA Programme
[222] PFA - 100/200
HIT Programme
[204] HIT - I (Immunological testing)
ACT Programme
[504] Activated Clotting 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 study on bleeding disorders (1 survey per year)
[706] Case study on anticoagulation bridging (1 survey per year)
[705] Pre- and post-analytical survey in haemostasis (1 survey per year)
Homocysteine Programme
(in co-operation with the DEKS, Denmark)
[1001] Homocysteine
Molecular Biology
(in co-operation with the SPMD, 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
DNA Seqencing SQ
[901] Sequencing and interpretation
DNA Isolation DI
[902] DNA Isolation and genotyping
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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
*
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Phone
*
Email
*
Use different contact details for
*
Sample person: receives samples
Report person: receives printed reports (pdf available on website)
Invoice: receives invoice
Always 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
*
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Phone
*
Email
*
Contact details "Report":
Title
First name
*
Surname
*
Hospital / Institute
*
Department / Laboratory
Street
*
ZIP code
*
Town / City
*
State
Country
*
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Phone
*
Email
*
Contact details "Invoice":
Title
First name
*
Surname
*
Hospital / Institute
*
Department / Laboratory
Street
*
ZIP code
*
Town / City
*
State
Country
*
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Phone
*
Email
*
Next
2 / 3
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?
Yes
No
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
3 / 3
When you have any question, please contact us via: info@ecat.nl
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
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