Stats Registration

<!doctype html> <html> <head> <meta charset="utf-8"> <meta name="viewport" id="vp" content="initial-scale=1.0,user-scalable=no,maximum-scale=1,width=device-width" /> <meta name="viewport" id="vp" content="initial-scale=1.0,user-scalable=no,maximum-scale=1" media="(device-height: 568px)" /> <script async src="https://www.googletagmanager.com/gtag/js?id=UA-130119311-1"></script> <script> window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'UA-130119311-1'); </script> <link rel="stylesheet" type="text/css" href="/res/css/css.php?pg=statssignup"/> <link rel="stylesheet" href="//code.jquery.com/mobile/1.4.3/jquery.mobile-1.4.3.min.css" /> <script language="javascript" type="text/javascript" src="/res/js/jq.js"></script> <script language="javascript" type="text/javascript" src="/res/js/js.php?pg=statssignup"></script> <script language="javascript" type="text/javascript" src="/res/js/jquery.simpleplaceholder.js"></script> <script src="//code.jquery.com/mobile/1.4.3/jquery.mobile-1.4.3.min.js"></script> <script src="https://www.google.com/recaptcha/api.js" async defer></script> <title>Stats Registration</title> </head> <body> <div id="pgframe"> <div id="ilo" style="visibility:hidden;position:absolute">0</div> <div id="head"> <div id="head"> <div id="hdglass"> <div id="hdbg1"> <div id="hdbg2"> <div id="hdbg3"> <div id="headgloss"> </div> </div> </div> </div> </div> <a href="/index.php" data-ajax="false"><span id="homelink"></span></a> <span id="headhomemnuitm"> <ul> <a href="/index.php" data-ajax="false"><li class="sel">Home</li></a> <hr /> </ul> </span> </div> </div> <div id="body"> <div id="c1" class="col"> <div id="menu"> <ul> <a href="/aboutus.php" data-ajax="false"><li>About RNA Medical</li></a> <hr /> <a href="/products.php?type=0" data-ajax="false"><li>Products</li></a> <hr /> <a href="/stats.php" data-ajax="false"><li>Statistical Services</li></a> <hr /> <a href="/inserts.php" data-ajax="false"><li>Inserts/SDS</li></a> <hr /> <a href="/pricelist.php" data-ajax="false"><li>2025 Price List</li></a> <hr /> <a href="/orderinginfo.php" data-ajax="false"><li>Ordering Info</li></a> <hr /> <a href="/faq.php" data-ajax="false"><li>FAQ</li></a> <hr /> <a href="/contactus.php" data-ajax="false"><li>Contact</li></a> <hr /> <a href="/survey.php" class="lastmnuitm" data-ajax="false"><li>Customer Survey</li></a> </ul> </div> <div id="menuend"></div> <div id="colframe"> <p class="hd1">Contact RNA Medical</p> <p>7 Jackson Rd<br>Devens, MA 01434 USA<br>Sales: (800) 533-6162<br />Phone: (978) 772-9070<br />Fax: (978) 964-0537</p> </div> </div> <div id="c2frame" class="col"> <div id="c2" class="col"> <div id="colframe"> <p class="hd1">PeerQC Registration</p> <br> <p>Thank you for your interest in RNA Medical's PeerQC program. Please complete the registration form below and click submit. Our helpful Statistical Services representatives will setup your account and contact you.</p> <br /> <div id="results"> </div> <form id="signupfrm" name="signupfrm"> <div class="sufrmheader"> <span><img src="/res/img/signupacct.png" width="32" height="32" /></span> <span class="suheadtxt">Laboratory Information</span> </div> <br> <input id="facility" name="facility" data-mini="true" placeholder="Facility" type="text" value="" /> <input id="dept" name="dept" data-mini="true" placeholder="Department" type="text" value="" /> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="fname" name="fname" data-mini="true" placeholder="First Name" type="text" value="" /></div> <div class="ui-block-b"><input id="lname" name="lname" data-mini="true" placeholder="Last Name" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="email" name="email" data-mini="true" placeholder="E-mail Address" type="text" value="" /></div> <div class="ui-block-b"><input id="emailconf" name="emailconf" data-mini="true" placeholder="Confirm E-mail Address" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="phone" name="phone" data-mini="true" placeholder="Phone Number" type="text" value="" /></div> <div class="ui-block-b"><input id="ext" name="ext" data-mini="true" placeholder="Extension" type="text" value="" /></div> </fieldset> <input id="fax" name="fax" data-mini="true" placeholder="Fax Number" type="text" value="" /> <br><br><br> <div class="sufrmheader"> <span><img src="/res/img/signupaddr.png" width="32" height="32" /></span> <span class="suheadtxt">Address Information</span> <br><br> </div> <input id="addr1" name="addr1" data-mini="true" placeholder="Address 1" type="text" value="" /> <input id="addr2" name="addr2" data-mini="true" placeholder="Address 2" type="text" value="" /> <fieldset class="ui-grid-b"> <div class="ui-block-a"><input id="city" name="city" data-mini="true" placeholder="City" type="text" value="" /></div> <div class="ui-block-b"><input id="state" name="state" data-mini="true" placeholder="State" type="text" value="" /></div> <div class="ui-block-c"><input id="zip" name="zip" data-mini="true" placeholder="Zip Code" type="text" value="" /></div> </fieldset> <br><br><br> <div class="sufrmheader"> <span><img src="/res/img/signupsec.png" width="32" height="32" /></span> <span class="suheadtxt">Instrument 1 Information</span> </div> <br><br> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst1mfg" name="inst1mfg" data-mini="true" placeholder="Manufacturer" type="text" value="" /></div> <div class="ui-block-b"><input id="inst1model" name="inst1model" data-mini="true" placeholder="Model" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst1serial" name="inst1serial" data-mini="true" placeholder="Serial Number" type="text" value="" /></div> <div class="ui-block-b"><input id="inst1name" name="inst1name" data-mini="true" placeholder="ID/Name" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst1qcprod" name="inst1qcprod" data-mini="true" placeholder="QC Product" type="text" value="" /></div> <div class="ui-block-b"><input id="inst1qclot1" name="inst1qclot1" data-mini="true" placeholder="Lot #1/Kit Lot#" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst1qclot2" name="inst1qclot2" data-mini="true" placeholder="Lot #2" type="text" value="" /></div> <div class="ui-block-b"><input id="inst1qclot3" name="inst1qclot3" data-mini="true" placeholder="Lot #3" type="text" value="" /></div> </fieldset> <br><br><br> <div class="sufrmheader"> <span><img src="/res/img/signupsec.png" width="32" height="32" /></span> <span class="suheadtxt">Instrument 2 Information</span> </div> <br><br> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst2mfg" name="inst2mfg" data-mini="true" placeholder="Manufacturer" type="text" value="" /></div> <div class="ui-block-b"><input id="inst2model" name="inst2model" data-mini="true" placeholder="Model" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst2serial" name="inst2serial" data-mini="true" placeholder="Serial Number" type="text" value="" /></div> <div class="ui-block-b"><input id="inst2name" name="inst2name" data-mini="true" placeholder="ID/Name" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst2qcprod" name="inst2qcprod" data-mini="true" placeholder="QC Product" type="text" value="" /></div> <div class="ui-block-b"><input id="inst2qclot1" name="inst2qclot1" data-mini="true" placeholder="Lot #1/Kit Lot#" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst2qclot2" name="inst2qclot2" data-mini="true" placeholder="Lot #2" type="text" value="" /></div> <div class="ui-block-b"><input id="inst2qclot3" name="inst2qclot3" data-mini="true" placeholder="Lot #3" type="text" value="" /></div> </fieldset> <br><br><br> <div class="sufrmheader"> <span><img src="/res/img/signupsec.png" width="32" height="32" /></span> <span class="suheadtxt">Instrument 3 Information</span> </div> <br><br> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst3mfg" name="inst3mfg" data-mini="true" placeholder="Manufacturer" type="text" value="" /></div> <div class="ui-block-b"><input id="inst3model" name="inst3model" data-mini="true" placeholder="Model" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst3serial" name="inst3serial" data-mini="true" placeholder="Serial Number" type="text" value="" /></div> <div class="ui-block-b"><input id="inst3name" name="inst3name" data-mini="true" placeholder="ID/Name" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst3qcprod" name="inst3qcprod" data-mini="true" placeholder="QC Product" type="text" value="" /></div> <div class="ui-block-b"><input id="inst3qclot1" name="inst3qclot1" data-mini="true" placeholder="Lot #1/Kit Lot#" type="text" value="" /></div> </fieldset> <fieldset class="ui-grid-a"> <div class="ui-block-a"><input id="inst3qclot2" name="inst3qclot2" data-mini="true" placeholder="Lot #2" type="text" value="" /></div> <div class="ui-block-b"><input id="inst3qclot3" name="inst3qclot3" data-mini="true" placeholder="Lot #3" type="text" value="" /></div> </fieldset> <br><br><br><br> <div class="sufrmheader"> <span><img src="/res/img/captcha.png" width="32" height="32" /></span> <span class="suheadtxt">Enter the Security Code in the Box Below:</span> </div> <div class="g-recaptcha" data-sitekey="6LfH2n0UAAAAAExt32Bl__dg61Oq9-To_8jzJ-7D"></div> <br><br><br> <input type="button" onClick="Javascript:SubmitStatsSignup()" value="Sign Up" />  <input type="button" onClick="Javascript:StatsStartOver()" value="Start Over" /> <br><br><br><br> </form> </div> </div> </div> <div id="c1b"> <div class="center"> <img src="/res/img/peerqc.gif" class="img" width="115" height="30" /> </div> <p><a href="/stats.php" data-ajax="false">PeerQC Patent Award</a></p> <br>  <hr class="smhr" /> <br> <div id="rndhemebadge"> <a href="/rndheme.php" target="_blank"><img src="/res/img/rndhemelogo.jpg" alt=" R&D Hematology " width="64" height="41" border="0"></a> <br /> Looking for a full suite of whole blood Hematology controls and calibrators for hospitals and clinical laboratories? If so, please visit <a href="/rndheme.php" target="_blank">R&D Systems</a> for a full range of products available to meet your needs! </div> </div> </div> <div id="foot"> <div id="footbg"> <div id="footgloss"> <p>Copyright © 2025 RNA Medical. All Rights Reserved. || <a href="privacy.php">Privacy Policy</a> || Trademarks<br />RNA Medical, PeerQC, and Safe-Wrap are a registered trademarks of Bionostics, Inc., Devens, MA, USA.<br />DCA and DCA Vantage are registered trademarks of Siemens Medical Solutions Diagnostics Corporation, IL, USA.</p> </div> </div> </div> </div> <script>$('input:text[placeholder]').simplePlaceholder(); </script></script> </body> </html>

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