PHARLEX® pharma license exchange - Registration Form

Registration Form

(* mandatory fields)

Event:

tbc (pre-registration)

Salutation:

*

First name:

*

Middle name:

Last name:

*

Job title:

*

Company name:

*

Address:

*

City/Town:

*

State/Province:

*

Zip/Postal code:

*

Country:

*

Phone, main:

*

Phone, direct:

Phone, mobile:

Fax:

*

Email:

*

Website:

*

Registration type:

*

Select 1-4 sections:

	Seek	Offer	Seek&Offer	N/A
Innovations:
Proprietary Rx:
Generics:
OTC/Heath:

*

Business development objectives:

(max. 2,000 characters)

Points to consider when completing: - Deal-type, ie. licensing, distribution, co-development etc. - Stage of development - Type of product or technology - Therapeutic or medical area - Territory

*

Company synopsis:

(max. 2,000 characters)

Points to consider when completing: - Size and brief history of company - Main scopes of company’s business - The company’s strengths as they relate to your objectives, etc.

*

Company logo upload:

Accommodation:

*

Special requirements

or comments:

(max 2000 characters)

Notes:

By submitting this form, you agrees to pay the applicable registration fee in full upon receipt of invoice and you confirm agreement with the terms and conditions posted under 'Policies'.

Discounts will be applied to each invoice in accordance with pricing information provided under 'Current Forum'.

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