Evolving Economies Discount – Application Form

To allow us to assess your application we require that you complete the following form. Applications are reviewed on receipt by EMQN and you will be informed of the outcome (usually within 5 working days). The application can be submitted before opening an account so that organisations can check if they are accepted to the Evolving Economies Discount Scheme, before registering for an account with EMQN CIC, or purchasing any schemes. If rejected, the organisation can still apply for an account, but the scheme fees will be charged at the full price.

Please note that the registration period for Germline schemes is usually September – November for and September to February for Technical and Molecular Pathology Schemes. Approval of any application does not guarantee access to schemes where the registration period is closed for that year.

If a laboratory is accepted on the evolving economies scheme, the following EQA scheme fee structure applies:

Year 1 – 100% discount
Year 2 – 75% discount
Year 3 – 50% discount
Year 4 – 25% discount
Year 5 – Full scheme(s) fees payable.

Fees will be automatically discounted if the application is approved. If a purchase has already been made, EMQN will adjust any invoices accordingly.

Applications from counties not listed on the Evolving Economies list will be rejected.

Organisation Name: *

Organisation Address: *

Please enter Postcode/Zip Code: *

Full Name of Requester: *

If you already have an EMQN account, please enter your Lab ID Number:

E-mail Address: *

Organisation website URL: *

http://

Laboratory Information

How would you classify your laboratory: *

Public

Private

Public - Not for Profit

Other

How long have you been offering diagnostic genetic testing: (in years) *

Approximately how many laboratories that offer diagnostic molecular genetic testing are there in your country? *

Approximately how many results do you report per year? *

Size of laboratory (approx. No of staff): *

How many different tests does your laboratory offer: *

Which EQA schemes would you wish to participate in? *

Please make a statement below to describe why your laboratory should qualify for an evolving economies discount. *

Terms and conditions (please tick ALL boxes): *

The laboratory agrees to participate in at least one EQA scheme every year, for 5 consecutive years.

The laboratory agrees to pay any non-discounted portion of the EQA scheme fees (applicable to that year).

The laboratory agrees to pay the full EQA scheme fees for the fifth year of participation.

The laboratory agrees to notify EMQN immediately of any changes to their contact information.

I confirm my agreement with the terms and conditions of this agreement as described on the preceding pages.