Merck VIP Forum Application
1:1 Sessions will be held with representatives from Merck on October 4th. LSWI will reach out to you by September 26 if you are selected for a meeting.
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1.
First Name
(Required.)
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2.
Last Name
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3.
Professional Title
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4.
Phone
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5.
Email Address
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6.
Company name
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7.
Street address
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8.
City
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9.
State
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10.
Website
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11.
Year incorporation/ formation
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12.
Number of employees
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13.
Subsector (select one)
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Biotech
Medtech
Digital Health/Health IT
Global Health
Research Institute
None of the above
Other (please specify)
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14.
Technology Classification (select all that apply)
(Required.)
Medical Device
Diagnostic
Platform Technology
Therapeutic
Software
Other (please specify)
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15.
Area of focus (select all that apply)
(Required.)
Oncology
Novel tumor dependencies directly linked to growth and survival
Differentiated approaches to validated targets
Tumor-intrinsic/tumor-selective targets grounded in patient biology
Off-the-shelf cell therapies in solid tumors
Cardiometabolic Diseases
CV: Heart Failure (HFpEF), PAH
Metabolic: NASH, Obesity
Renal: Chronic Kidney Disease
Ophthalmology: Dry AMD/Geographic Atrophy
Fibrosis: COPD, IPF
Neuroscience
Neurodegenerative Diseases: AD/PD/ALS
Psych
Pain
Itch
Symptomatic for neurodegenerative
Mitophagy/Autophagy/Lysosomal
ER Stress
Infectious Diseases and Vaccines
HIV therapeutics
Pan-respiratory antivirals and vaccines
Long-acting respiratory therapeutics and prophylactics
Vaccines for Norovirus, CMV, HSV, EBV, PCV, HPV, and RSV
HBV functional cure
Therapeutic vaccines for HIV
Broad spectrum antibiotics
Novel vaccine delivery platforms (oral, needle free, extended release)
Novel adjuvants
Immunology
Gut inflammatory diseases (IBD, UC, CD)
Multiple Sclerosis
Rheumatoid arthritis
Systemic Lupus
GvHD
Celiac disease
Asthma
Modulators of:
immune homeostasis
cytokine networks
lymphocytes signaling
Other (please specify)
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16.
Management team and Board (200 word max)
(Required.)
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17.
Target / Underlying Biology / MOA / Modality
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18.
Disease area(s) / Disease(s) targeted
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19.
Description of your technology (200 word max)
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20.
Development Stage
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Pre-Clinical
IND
Phase I
Phase II
Phase III
Approved
NDA
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21.
Key partnership objectives (200 word max)
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22.
Current partnerships and/or alliances (200 word max)
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23.
Key next steps in development
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24.
Are you generating revenue?
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Yes
No
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25.
Recent milestones and next steps (200 word max)
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26.
Status of Intellectual Property
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License pending
License executed
Provisional patent filed
Patent pending
Patent issued
PCT application filed
Other (please specify)
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27.
Ownership
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28.
Capital raised to date and funding history
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29.
Amount of capital sought, and milestones to be achieved on that capital (200 word max)
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