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Membership

Membership application

Complete the form below. An authorised officer must confirm the sanctions representations before submitting.

Application form

Company information

Legal company name *

Doing business as

EIN

Year founded

Website Headquarters address U.S. manufacturing facility addresses

One per line.

Primary contact

Name *

Title

Email *

Phone

Ownership and control

Parent company

Jurisdiction of organisation

Beneficial owners (10%+) and controlling persons

Name, nationality, country of residence, ownership percentage and nature of control.

Is the applicant majority U.S.-owned and U.S.-controlled? If no, please explain Is any owner or controller a government entity? If yes, identify the owner and government entity

U.S. manufacturing and compliance Product categories manufactured in the U.S.

Respirators Surgical/procedural masks Isolation/surgical gowns Nitrile gloves Face shields and eyewear Caps and boot covers Drapes and sterile barriers Raw materials or components Equipment or machinery Other

Relevant certifications and approvals Adverse findings or FDA warning letters in the last 34 months? If yes, please explain Any relationships with AMMA directors, officers or committee members? Requested membership type

OFAC and sanctions representations

Each representation must be confirmed individually.

Neither the applicant nor any 10%+ beneficial owner, parent or controlling person appears on any OFAC sanctions list, including the SDN list. The applicant is not majority-owned or controlled by any person or entity on an OFAC sanctions list. The applicant is not majority-owned or controlled by any person or entity organised in, or with its principal place of business in, a comprehensively sanctioned country or region, and no director, officer or key manager is ordinarily resident there. The applicant maintains an internal control process designed to ensure ongoing compliance with U.S. sanctions. The applicant will promptly notify AMMA if any of these representations cease to be accurate.

Certification

Authorised officer *

Officer title

I certify that the information given above is true and accurate, and that I am authorised to submit this application on behalf of the applicant.

Your name, the date and your network address are recorded with this application as the record of that certification.

Prefer the printed form? Download the PDF.

The American Medical Manufacturers Association is the leading alliance of domestic makers of PPE and critical medical supplies — bringing strategic medical manufacturing back to America.

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