Transcelerate Biopharma Inc. Membership Application

TransCelerate BioPharma Inc. Membership Application

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TransCelerate BioPharma Inc.

Membership Application

Thank you for your interest in membership. TransCelerate membership is available to pharmaceutical and biopharmaceutical companies with R&D organizations who engage in innovative discovery, development, and manufacturing of new drugs. We have three membership classes that define our dues and resource contributions. For questions on membership eligibility and dues please contact .

Applicant Information

Company Name

Primary Company Contact

Address

City State Zip

Email Phone Fax

Membership Class Requested

Eligibility for membership in a particular class is based on the applicant’s publicly available annual budget for research and development over the three years preceding the date of the application and additional criteria included in the TransCelerate BioPharma Inc. (“TransCelerate”) bylaws.

☐ Tier 1 Member ______(Annual R&D budget in excess of $2.5 Billion)

☐ Tier 2 Member ______(Annual R&D budget over $100 million but less than $2.5 billion)

☐ Associate Member ______(Annual R&D budget of less than $100 million)

Dues

Member dues are established by the TransCelerate Board of Directors on an annual basis and vary based on membership class (above). Members may also be subject to special project assessments.

Applicant Acknowledgment

The Applicant acknowledges that the following terms and conditions apply to this Application and TransCelerate membership:

·  The Application is subject to acceptance by the Board of Directors, including verification of the Applicant’s eligibility for membership in a particular class.

·  Upon acceptance of the Application, the Applicant will become a TransCelerate member only upon (i) execution of the TransCelerate Membership Agreement and (ii) payment of initial and annual dues.

·  The Applicant agrees to be bound by the terms of the TransCelerate Articles of Incorporation, Bylaws and the policies which the TransCelerate Board of Directors may, from time to time, adopt.

Signature of Applicant’s Authorized Representative

______

Name:______

Title:______

Date:______

Please submit the completed application to .

Last updated on March 24, 2015