The $1M ALS Biomarker Prize Has Been Won!
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Biomarker Prize
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Treatment Prize
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<table width="100%" border="0" cellspacing="0" cellpadding="0" bgcolor="#FFFFFF"> <tr> <td><span class=default> <!-- <div id="translate-this"><a href="http://translateth.is/" class="translate-this-button">Translate</a></div> <script type="text/javascript" src="http://www.google.com/jsapi"></script> <script type="text/javascript" src="http://x.translateth.is/translate-this.js"></script> <script type="text/javascript"> TranslateThis(); </script> --> <!-- startprint --> <span class=default><!-- ---------------------------------------------------------------------- --><!-- NOTE: Please add the following <META> element to your page <head>. --><!-- If necessary, please modify the charset parameter to specify the --><!-- character set of your HTML page. --><!-- ---------------------------------------------------------------------- --><!-- ---------------------------------------------------------------------- --><!-- NOTE: Please add the following <FORM> element to your page. --><!-- ---------------------------------------------------------------------- --> <form method="post" action="https://www.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8"> <table cellspacing="3" cellpadding="3" border="0"> <tbody> <tr> <td><label for="label"> <div align="right">First Name</div></label></td> <td width="5"> </td> <td><input id="first_name" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="40" name="first_name"></td></tr> <tr> <td><label for="label"> <div align="right">Last Name</div></label></td> <td width="5"> </td> <td><input id="last_name" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="80" name="last_name"></td></tr> <tr> <td><label for="label"> <div align="right">Title</div></label></td> <td width="5"> </td> <td><input id="title" maxlength="40" name="title"></td></tr> <tr> <td> <div align="right">Research/Clinical Field:</div></td> <td width="5"> </td> <td><input id="00N70000001lLxj" maxlength="100" name="00N70000001lLxj"></td></tr> <tr> <td><label for="label"> <div align="right">Email</div></label></td> <td width="5"> </td> <td><input id="email" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="80" name="email"></td></tr> <tr> <td><label for="street"> <div align="right">Address</div></label></td> <td width="5"> </td> <td><textarea name="street"></textarea></td></tr> <tr> <td> <div align="right">Address 2:</div><label for="label"></label></td> <td width="5"> </td> <td><input id="00N70000001lGiC" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="255" name="00N70000001lGiC"></td></tr> <tr> <td><label for="label"> <div align="right">City</div></label></td> <td width="5"> </td> <td><input id="city" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="40" name="city"></td></tr> <tr> <td><label for="label"> <div align="right">State/Province</div></label></td> <td width="5"> </td> <td><input id="state" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="20" name="state"></td></tr> <tr> <td><label for="label"> <div align="right">Country</div></label></td> <td width="5"> </td> <td><input id="country" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="40" name="country"></td></tr> <tr> <td><label for="label"> <div align="right">Zip</div></label></td> <td width="5"> </td> <td><input id="zip" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="20" name="zip"></td></tr> <tr> <td><label for="label"> <div align="right">Phone</div></label></td> <td width="5"> </td> <td><input id="phone" title="Your Google Toolbar can fill this in for you. Select AutoFill" style="background-color: #ffffa0" maxlength="40" name="phone"></td></tr> <tr> <td><label for="label"> <div align="right">Mobile</div></label></td> <td width="5"> </td> <td><input id="mobile" maxlength="40" name="mobile"></td></tr> <tr> <td><label for="label"> <div align="right">Fax</div></label></td> <td width="5"> </td> <td><input id="fax" maxlength="40" name="fax"></td></tr> <tr> <td><label for="label"> <div align="right">Website</div></label></td> <td width="5"> </td> <td><input id="URL" maxlength="80" name="URL"></td></tr> <tr> <td> <div align="right">Primary Affiliation:</div></td> <td width="5"> </td> <td><select id="00N70000001lGi7" title="Primary Affiliation" name="00N70000001lGi7"> <option value="" selected="selected">--None--</option> <option value="Academic">Academic</option> <option value="Government">Government</option> <option value="Hospital/Clinical">Hospital/Clinical</option> <option value="Industry">Industry</option> <option value="Non-profit">Non-profit</option> <option value="Private practice">Private practice</option> <option value="Unaffiliated">Unaffiliated</option></select> </td></tr> <tr> <td> <div align="right">Which prize are you competing for?:</div></td> <td width="5"> </td> <td><select id="00N70000002Czsd" title="Which prize are you competing for?" name="00N70000002Czsd"> <option value="" selected="selected">--None--</option> <option value="Biomarker Prize">Biomarker Prize</option> <option value="Treatment Prize">Treatment Prize</option> <option value="Both prizes">Both prizes</option></select> </td></tr> <tr> <td> <div align="right">Competition Status:</div></td> <td width="5"> </td> <td><select id="00N70000001lGiW" title="Competition Status" name="00N70000001lGiW"> <option value="" selected="selected">--None--</option> <option value="Team">Team</option> <option value="Individual">Individual</option></select> </td></tr> <tr> <td> <p align="right">Research/Idea Description:</p> <p align="right"> </p></td> <td width="5"> </td> <td><textarea id="00N70000001lGiH" name="00N70000001lGiH" rows="5" type="text"></textarea></td></tr> <tr> <td> <div align="right">Publications:</div></td> <td width="5"> </td> <td><textarea id="00N70000001lGiM" name="00N70000001lGiM" rows="5" type="text"></textarea></td></tr> <tr> <td> <p align="right">How did you hear about us?:</p> <p align="right">(ctrl + click to select multiple options)</p></td> <td width="5"> </td> <td><select id="00N70000001lM5N" title="How did you hear about us?" multiple="multiple" name="00N70000001lM5N"> <option value="ALS patient">ALS patient</option> <option value="Another ALS organization">Another ALS organization</option> <option value="Another Researcher">Another Researcher</option> <option value="Article">Article</option> <option value="Conference/Meeting">Conference/Meeting</option> <option value="InnoCentive">InnoCentive</option> <option value="Our website">Our website</option> <option value="Personal Acquaintance">Personal Acquaintance</option> <option value="Print Ad">Print Ad</option> <option value="Prize4Life Affiliate">Prize4Life Affiliate</option> <option value="Program Officer">Program Officer</option> <option value="Web Ad">Web Ad</option> <option value="Web Search">Web Search</option></select> </td></tr> <tr> <td> </td> <td> </td> <td> </td></tr> <tr> <td> <div align="right"></div></td> <td width="5"> </td> <td><input type="submit" value="Submit Information" name="submit"></td></tr></tbody></table><input type="hidden" value="00D700000008EEW" name="oid"> <input type="hidden" value="http://www.prize4life.org/page/registration_confirmation" name="retURL"> </form></span> <!-- stopprint --> </span></td> </tr> </table>
