Submission form sheet Memento Preis für vernachlässigte Krankheiten 2017 Ärzte ohne Grenzen e.V. / DAHW Deutsche Lepra- und Tuberkulosehilfe e.V. / Brot für die Welt e.V. / BUKO Pharma-Kampagne Topic: [please include one headline] Institution [institution name] Corresponding Author [name] Website [website] Contact References [Email] [Phone number] [please include max. 5 scientific publications] Summary [additional: If available, please include reports in public media: TV, radio, newspapers] [summary of your project, max. 2 pages] Relevance for the MementoPreis? Easy to explain to the public? [What makes your project relevant for the Memento Preis? 0,5 page max.] [Include a short explanation if you think your topic is easy to explain to nonscientific audience] Submission max. 3 pages, plus additional max. 5 scientific publications as pdf-documents Please send to [email protected] 1