Partnering Opportunity Submission Form

Updated Feb 21st 2011

Orion Corporation, Orionintie 1A, 02200 Espoo, PO Box 65, FI-02101 Espoo, Finland
Phone +358 104261 © Copyright Orion Corporation. Company code, VAT 19992126,

		The fields marked with an asterix (*) are required to be filled.
First Name*
Last name *
Name of Company / Institution *
Company / Institution web address (if any) *
Company / Institution Address
Zip Code
City
Country
Telephone
Fax
E-mail Address


Offered Opportunity *
1. Nature of Opportunity		Compound Product Technology
2. Development Phase		2. Development Phase Marketed Approved Registration phase Phase III Phase II Phase I Preclinical
3. Therapy area		3. Therapy area Asthma/COPD Cardiology Central Nervous System Disorders Critical Care / ICU setting Oncology Pain Urology Other (please specify below)

4. Is there Intellectual Property protection available or filed for the opportunity? *		YesNo
5. If so, what kind? *		Composition of matter Formulation Use Process Data exclusivity
6. What markets are covered by the patents?
7. Is clinical data available? *		Yes No
If so, at what phase? *
8. What other data is available?
9. How widely is the opportunity available for licensing (geographies, indications)? *
10. Please describe for us what the benefits of the opportunity are compared to the conventional therapies. Please also describe the proposed structure for the collaboration, if Orion were to pursue it further.