Application for Changes To EPHMRA / INTELLUS - Anatomical Classification System

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* 1. Your Details:

Full Name

Company

Address

Country

Tel Number

Email

Date of Request

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* 2. Are you, the requestor, located at the company’s worldwide corporate headquarters?

Yes

No

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* 3. If answer is ‘no’ (i.e. not at HQ), then please provide contact information of corporate headquarters person who has approved this request eg name, email address, job title.

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* 4. Please provide a brief overview of the reasons for the change request:

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* 5. Please provide your proposed new class structure and include class names, class descriptions, products and/or types of products to be included in new and affected classes:

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* 6. Please list current classes that may be affected by proposed change:

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* 7. Please reference or email any background information - email to generalmanager@ephmra.org

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* 8. Many thanks – we will get back to you in due course.