Prix Galien - Pharmaceuticals

Submit your application

You can indicate your intention to submit one or more files for the Galenus Prize for Pharmaceuticals - 43th edition by completing the form below. By clicking "save," an email containing a link will be sent to you, enabling you to revisit and finish this form at your convenience.
First name*
Last name*
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example@example.com
Company name*
Company address*

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VAT Number*
Phone Number*
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Follow-up email address (optional)
You can fill out the name of a colleague who wants access to this entry
On the bottom of the ‘jotform popup window’ click on 'Skip Create an Account' when saving your application.

Application details

Please provide us with the PDF's before 15/03/2024
Please select your application type*

The best pharmaceutical agentThe best pharmacological research project
How many design applications would you like to submit?*

1 Application2 Applications3 Applications4 Applications
Estimated submission fee
For all applications
PO number
Upload your company logo (min. 1000x1000px .png)*

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Prix Galien - Application form

Please fill out the details of your application below
- For more details on the criteria regulation click here for the extended regulations
- Application name*
- Application file - English (pdf)
- - Please use Calibri font, 11 pt, 1.5 line spacing
  - Summarize the key characteristics of the medical device
  - Add a complete bibliography
  - Conclude with a statement (in English) why the proposed medical device is worthy of the Prix Galien
  - Include an explanatory list of abbreviations used
- Upload the application file here*
  
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- Summary application file - Dutch (pdf)*
  
  Summary of maximum 3 pages in Dutch
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- Summary application file - French (pdf)*
  
  Summary of maximum 3 pages in French.
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- Approved application 1
- For more details on the criteria regulation click here for the extended regulations
- Application 2 - Name*
- - Please use Calibri font, 11 pt, 1.5 line spacing
  - Summarize the key characteristics of the medical device
  - Add a complete bibliography
  - Conclude with a statement (in English) why the proposed medical device is worthy of the Prix Galien
  - Include an explanatory list of abbreviations used
- Application file - English (pdf)
- Application file - English (pdf)*
  
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- Summary application file - Dutch (pdf)*
  
  Cancelof
- Summary application file - French (pdf)*
  
  Cancelof
- Approved application 2
- For more details on the criteria regulation click here for the extended regulations
- Dossier 3 - Name*
- - Please use Calibri font, 11 pt, 1.5 line spacing
  - Summarize the key characteristics of the medical device
  - Add a complete bibliography
  - Conclude with a statement (in English) why the proposed medical device is worthy of the Prix Galien
  - Include an explanatory list of abbreviations used
- Application file - English (pdf)
- Application file - English (pdf)*
  
  Cancelof
- Summary application file - Dutch (pdf)*
  
  Cancelof
- Summary application file - French (pdf)*
  
  Cancelof
- Approved application 3
- For more details on the criteria regulation click here for the extended regulations
- Dossier 4 - Name*
- Application file - English (pdf)
- - Please use Calibri font, 11 pt, 1.5 line spacing
  - Summarize the key characteristics of the medical device
  - Add a complete bibliography
  - Conclude with a statement (in English) why the proposed medical device is worthy of the Prix Galien
  - Include an explanatory list of abbreviations used
- Application file - English (pdf)*
  
  Cancelof
- Summary application file - Dutch (pdf)*
  
  Cancelof
- Summary application file - French (pdf)*
  
  Cancelof
- Approved application 4
- On the bottom of the ‘jotform popup window’ click on 'Skip Create an Account' when saving your application.
- Should be Empty:

Submit your application

Application details

Prix Galien - Application form

Application file - English (pdf)

Application file - English (pdf)

Application file - English (pdf)

Application file - English (pdf)