PGUSA 2024 Submissions USA (Preview)

Select a category of submission *

Prix Galien StartUp 2023 Application Form

General Information

Company Name *

Number of employees *

Turnover and/or Funding

Sub-Category *

Product/Solution Name *

Compound/Tech Name *

Trade Name *

Corporate Name *

Date of Approval *

Indications *

Therapeutic Areas *

Document upload

Background information and need for drug/device * Background information and need for solution/product * Please provide clear benefits, improving patient care or health outcomes. *

Background (500 words)

Corporate history (creation, key milestones, main funding,…)
Information on Condition / Disease and need for solution / product (prevalence, existing treatments / solutions)

History of the development of the fund / Incubators (500 words)

Focus (500 words)

Document upload

DEVELOPMENT & CLINICAL OR PRECLINICAL EVIDENCES (500 words)

History of the development of the solution/product *

History of the development of the solution/product (Intellectual Property, preclinical and clinical datas, development collaborations) *

Please provide valuable insights or findings that could influence future biomedical research or healthcare practices. * How do you address your portfolio needs *

Impact / Metrics to measure Success *

Document upload

Innovation (500 words) Why this drug or device is innovative, the broad implications for future research, and/or how it will improve the human condition * Why this solution/product is innovative, the broad implications for future research, and/or how it will improve the human condition * The effects of your research on improving accessibility, effectiveness, and quality of life enhancements. * Why you model is innovative, \and/or how it will improve the human condition *

Document upload

Please provide appropriate references (PubMed, Abstract, Website) *

Document upload

Thank you for submitting your innovation. Please note that your submission will be available for viewing and editing from your dashboard on this platform until the date of submission closure.

Please note that only complete submissions will qualify for judging.

Submission	Category	Resubmission	Status
No name	Best Pharmaceutical Product		Incomplete

	10 additional tickets to the Awards Ceremony		$16,500
	Individual combo ticket to the Awards Ceremony and Forum		$2,300
	Individual Award Ceremony ticket		$1,850
	Individual Forum ticket		$750

Bank Name:	JP Morgan Chase Bank
Branch Name:	Broadway Morris Exchange 294
Address:	42 Broadway, New York, NY 10004
ABA/routing number:	021000021
Account number:	515907223
Account name:	The Galien Foundation

Welcome

Submit your innovation

Select a category of submission *

DEVELOPMENT & CLINICAL OR PRECLINICAL EVIDENCES (500 words)

Submission
Startup Category

Submission
Incubator/Accelerator/Equity Category

Submission
Digital Health Solution Category (< 1,000 employees)

Submission
Digital Health Solution Category (> 1,000 employees)

Gold Contributor
Package

Silver Contributor
Package

Bronze Contributor
Package

Gold Contributor
Package

Silver Contributor
Package

Bronze Contributor
Package

10 additional tickets to the Awards Ceremony

Individual combo ticket to the Awards Ceremony and Forum

Individual Award Ceremony ticket

Individual Forum ticket

Welcome

Submit your innovation

Select a category of submission *

DEVELOPMENT & CLINICAL OR PRECLINICAL EVIDENCES (500 words)

Submission Startup Category

Submission Incubator/Accelerator/Equity Category

Submission Digital Health Solution Category (< 1,000 employees)

Submission Digital Health Solution Category (> 1,000 employees)

Gold Contributor Package

Silver ContributorPackage

Bronze ContributorPackage

Gold Contributor Package

Silver ContributorPackage

Bronze ContributorPackage

10 additional tickets to the Awards Ceremony

Individual combo ticket to the Awards Ceremony and Forum

Individual Award Ceremony ticket

Individual Forum ticket

Submission
Startup Category

Submission
Incubator/Accelerator/Equity Category

Submission
Digital Health Solution Category (< 1,000 employees)

Submission
Digital Health Solution Category (> 1,000 employees)

Gold Contributor
Package

Silver Contributor
Package

Bronze Contributor
Package

Gold Contributor
Package

Silver Contributor
Package

Bronze Contributor
Package