In order for your request to be reviewed by Amgen Australia, please complete all of the fields within the form below. The request will not be submitted if mandatory fields are incomplete. Please provide as much detail as possible where requested.
Please complete all fields
Detailed Program Description
Please provide the name of primary point of contact.
What is the mission or purpose of the requesting healthcare institution / organisation?
What are the start and end dates of the event, program or project? (dd/mm/yyyy format)
Please provide a full description & objectives / purpose of the event, program or project.
Detailed Donation Requirements
Please provide details on how the funds will be used.
Please provide the full legal address of the requesting institution / organisation
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Amgen is collecting personal information in this form in order to assess your request. Amgen is dedicated to handling personal information according to your preferences and our legal obligations.
For this purpose, Amgen may disclose your personal information to Amgen's related entities, as well as to trusted third parties and suppliers who assist Amgen. These related entities and third parties may be located in other countries including the United States of America and in Europe and Asia. Amgen remains accountable for all personal information it discloses and takes appropriate measures to ensure that the confidentiality of your information is safeguarded.
If you have any questions or comments about this Privacy Statement, or wish to access or correct your personal information or make a privacy complaint, please contact our Privacy Officer at:
Amgen Australia Pty Ltd
Level 7, 123 Epping Road
North Ryde, NSW 2113
Attn: Privacy Officer Email: email@example.com; Tel: +61 2 9870 1333.