Ecat | 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

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

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)

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

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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When you have any question, please contact us via: info@ecat.nl

ECAT registration form 2023

ECAT REGISTRATION FORM 2023

Annual subscription fee

ECAT Modules 2023

Main Programme

Lupus Programme

D-Dimer Programme

Screen Programme

APTT / PT Mixing Test Programme

Haemophilia Programme

Anticoagulation Programme

Thromboelastography Programme

Thrombin Generation Programme

PFA Programme

HIT Programme

ACT Programme

POCT INR QC Programme

Other surveys

Homocysteine Programme

Molecular Biology

Contact Information

Sample Person

Contact details "Report":

Contact details "Invoice":

Other information:

Verification