HDAward-Submission-Form

To apply for the Health Technology Excellence Award:

Please complete the information below. Applicants must represent a current member healthcare facility or health system.
Attach your submission. See our rules page for details about what to include in your essay. Note that only a single file can be uploaded. If you need to send additional documents, please email them to the address listed below.
Click the submit button. By submitting an application, you grant ECRI permission to use information from the application essay in published materials.

Questions? Contact Rob Schluth, Device Evaluation Group, at (610) 825-6000, ext. 5490; rschluth@ecri.org.

An asterisk (*) denotes a required field.

* Company:

Website:

* Contact Person:

Name(s) of Other Applicant(s):

* Email:

* Job Title:

* Phone:

Fax:

* Address 1:

Address 2:

* City or APO/AFO:

* State/Province/Region:

Zip/Postal Code:

Country:

Please attach your essay: