Privacy Notice and Authorization

I authorize Amgen and its contractors to use and/or disclose the personal health information I supply ("Personal Information") to (1) provide me with ENBREL informational and marketing materials via SMS, e-mail, direct mail, and/or telephone; (2) help improve, develop, and evaluate products, services, materials, and programs related to my condition or treatment; and (3) enroll me in ENBREL Support™ ("the Program"), which includes reimbursement services, nursing services, the option to join the ENBREL sharps mail-back program to receive sharps disposal containers, and disease management support; and (4) communicate with me via telephone or e-mail referencing ENBREL Support™. I understand Amgen and its contractors will not sell or rent my personal information, but that it may be used, disclosed, and/or transferred to other Amgen locations and/or to Amgen's contractors for the purposes described, or as required by law.

I am aware the ENBREL Privacy Statement is available at www.amgen.com.

My authorization will expire in 10 years or a shorter time period if required by state law, unless I cancel it sooner. I may cancel my authorization by sending a letter to Amgen, PO Box 68376, Indianapolis, IN 46268. Once Amgen receives and processes my cancellation letter, Amgen will not use my personal information going forward. I understand that cancelling my authorization will not affect any use of my information that occurred before my request was processed.

I am entitled to receive a copy of my Authorization and the ENBREL Privacy Statement. Print this page.

By checking the "I Accept" box, I am electronically signing this form (which has the same legal effect as a handwritten signature) and indicating I am at least 18 years old and authorize Amgen and its contractors to use and disclose my Personal Information for the purposes described above.

Please note: If you do not want your Personal Information used for the purposes described above, click the Cancel button to discontinue your registration.