Commercial Reg Form - Keele Licencing

Commercial Registration

The cost for a commercial licence is £100 per site per annum, which is payable after completing this commercial registration form.

This is an annual subscription. Please contact us if you wish to cancel.

Organisation Name(Required)

Email(Required)

Address(Required)

Street Address City County / State / Region ZIP / Postal Code Country

What is your role within the organisation?(Required)

After evaluating the tool, would you consider working with Keele University to implement and evaluate it in your clinical setting?(Required)

Yes

Where did you hear about the tool?(Required)

Please specify the clinical population you will use the tool with(Required)

Please indicate whether you intend to use the tool as part of a stratified approach and do you have the appropriate matched treatments in place?(Required)

Briefly describe your commercial operation and how you intend to use the tool (.e.g. workers compensation, health insurance, other)(Required)

How many sites will be using the tool?

A facility providing clinical care utilising the STarTMSK tool that is located within ONE postcode/zip (e.g. one hospital building with a 10 Physiotherapy suits is ONE SITE. Three separate hospitals with 1 physiotherapy suite each, but belonging to one overarching organisation and located in three different postcode/zip areas are THREE SITES

Select the number of sites required. Confirm purchase £100 per annum per site(Required)

Total

After submitting this form you will be taken to the payment page where you can add your payment details. Please make sure you select the correct amount of sites required.

This agreement is between your organisation and the University of Keele, a university established by the University of Keele Act 1962 (10&11 Eliz.2 Ch Xv) and the granting of a Royal Charter in 1962 of Keele, Staffordshire ST5 5BG ("Keele") and sets out terms that the parties have agreed upon to cover the licensing arrangements for the STarT MSK Tool which is owned by Keele.

The License Agreement shall be effective for 12 months from registration. It may be terminated by either party upon one (1) months' written notice to the other Party.

Keele University may also collect personal information supplied through the use of web-based forms. This information will not be supplied to any third party, and will only be used for subsequent communications.

The data will be kept for no longer than is required and in compliance with DPA. In submitting your personal information online, you are agreeing that University staff may use your details for the sole purpose of conducting the business of the University.

If at any time you no longer wish to receive information from Keele University, please respond to any email and state that you wish to 'unsubscribe'.