US MedEd Request Form U.S. & Canada MedEd Workshop Equipment Request FormUse this request form to order sawbones, workshop sets, power sets, and accessories. First Name(Required)Last Name(Required)Email(Required)Distributor Name(Required)Choose your territory and managing director(Required)SELECT OPTION BELOWEAST – Henry Bonin T&DC / Austin Chester ScoliosisWEST – Jay Edington T&DC / Jerry Campbell Scoliosis / Josh Ladd Ex-FixCANADAEvent DetailsEvent Type(Required)SELECT OPTION BELOWSales TrainingResident WorkshopJournal ClubIn-ServiceStaff/Nurse/Tech/PA WorkshopFellowship WorkshopSurgeon WorkshopOtherAnticipated Number of Healthcare Attendees(Required)Date of Event(Required) Deliver by Date(Required) Ship to Address(Required)Street AddressAddress Line 2(Required)Address Line 2City(Required)CityState / Province / Region(Required)State / Province / RegionPostal / Zip Code(Required)Postal / Zip CodeCountry(Required)CountryPhone Number(Required)Sawbone Lab or Cadaver Lab(Required)Sawbone LabCadaver Lab- Please Contact MedEd Dept.ConMed Power Sets and VicesWe will only ship the same quantity of vices/clamps as the number of power sets requestedVice & Clamp Quantity(Required)Enter a value between 0 and 6ConMed Power Sets (Includes drill, saw, wire drivers, and attachments)(Required)Enter a value between 0 and 6Product Samples (If only 1 or 2 items are needed.)Workshop SetsNote: These sets are for sawbones use only(Required) Pega – Fassier Duval (FD) Pega – FD Removal Kit Pega – Slim Nail Pega – Gap Nail Pega – Dror Paley Osteotomy System (DPOS) Pega – Pegs Pega – Lollipop Pega – SCFE Pega – GIRO Set Pega – GIRO 3D Models T&DC – Ossio Demo Kit T&DC – Supracondylar Elbow FX Kit T&DC – 3.5 Locking Cannulated Blade T&DC – 3.5 Locking Proximal Femur T&DC – DFOS Implant & Instrument (includes LPF instruments) T&DC – DFOS Wedge Instruments T&DC – SCFE 6.5/7.3 Cannulated Screws T&DC – Updated 4.0 Cannulated Screw System T&DC – PediFrag (2.7mm & 3.5mm Compression & Tubular Plates. T-Plates) T&DC PediFlex —— Include Flexnail Cutter T&DC – PediFoot T&DC – PediLoc Femur (Includes T15 Screws, 3.5 Contoured & Bowed Femur Plates) T&DC – PediLoc Tibia (includes 3.5mm Plates: Anterolateral, Narrow & Wide Medial Plates, T15 Screws) T&DC – PNP Femur T&DC – PNP Tibia T&DC – PediPlates T&DC – Clubfoot Casting Models T&DC – PAO Set T&DC – 3P Hip (includes BEAM & LPF) Ex-Fix – Orthex Set for Blounts Tibia (includes 1 full ring & 1 partial ring) Ex-Fix – Orthex Set for Foot Deformity (includes foot plate, arch) Ex-Fix – Drive Rail Set (includes drill bit & half pins) Scoliosis – VerteGlide 4.5mm Instrument & Implant Set Scoliosis – VerteGlide Surgistud Demo Scoliosis – VerteGlide 4.5mm Construct Demo Scoliosis – VerteGlide 5.5mm Construct Demo Scoliosis – ApiFix Demo Model & Set Scoliosis – Response Power Torque Demo Scoliosis – BandLoc Demo Kit Scoliosis – Firefly Demo Scoliosis – 7D Scoliosis – RESPONSE 5.5/6.0 Spine System Scoliosis – RESPONSE 4.5/5.0 Spine System Sports – MPFL Spica Table (includes dummy) Cerement Demo Kit – Bone Void Filler I will be using my own set for Lab (please notify MedEd Dept.) Reason for using your live clinical setsIf applicable, why are you using your live sets?Do you need multiples of any requested set? If so, list below.Exhibits / DisplaysTo make your workshop experience stand out, request additional display materials here (tablecloths, pop-up banners, acrylic models). *Some materials may not be available at times due to limited quantities.Tablecloths OrthoPediatrics branded 8′ – BLACK OrthoPediatrics branded 6′ – BLACK Scoliosis branded 8′ – BLACK Scoliosis branded 6′ – BLACK T&D branded 8′ – BLACK T&D branded 6′ – BLACK Banners OP Generic pop up listing all business including T&D, Scoliosis, Ex-Fix, OPSB, ET Acryllc Models Response 5.5/6.0 and 4.5/5.0 Combined T&D (Includes LCB, LPF, DFOS, PediLoc Femur, PNP-Femur) Orthex Large Bone PediFoot SawbonesPlease call sawbones at (206) 463-5551 to order your bones. Lead time is 6 weeks! OP will reimburse you for 50% of the cost of your sawbones. If you have any questions please contact the Medical Education Team.I understand the following policy below when submitting a MedEd Request(Required) 6-10+ days notice – Ideal notice that allows us ample time to check availability, reach out to other reps for help getting education sets moved, etc) 3-5 days notice – Minimum notice we require. Most likely we can still accommodate these requests, but no guarantees. 0-2 days notice – Due to other requests that were submitted in time, planning, and availability we are unable to fulfill short notice requests (same day or 1-2 days in advance of the event) Medical Education items must be returned within 3 business days of the event. If your event date got rescheduled and/or if you need an extension please let us know. Notes Δ
