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You are now leaving Amgen Australia’s website. Amgen Australia takes no responsibility for, and exercises no control over the organisation, views, or information contained on the server or site which you will be accessing. The information contained might not comply with the Australian regulatory environment.

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Do you want to link to other websites and leave Amgen.com.au?

You are now leaving Amgen Australia’s website. Amgen Australia takes no responsibility for the information contained on the Amgen international server or site which you will be accessing. The information you are about to access may not comply with the Australian regulatory environment.

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


What is the title of your event, program or project?
Please provide the full legal name of the requesting institution / organisation
Please provide the name of primary point of contact.
Title
First Name
Last Name
Please provide related contact information:
Phone
E-mail*
What is the mission or purpose of the requesting non-healthcare institution / organisation?

What are the start and end dates of the event, program or project? (dd/mm/yyyy format)
Start date
End date
Please provide a full description & objectives / purpose of the event, program or project*

What is the target audience for the program / event?*
Are there any event, program or project related material available? (e.g. draft agenda, flyer / brochure, or website information etc)
Yes   No
If yes, please attach with the auto-generated email at the end of this process


Detailed Donation Requirements


What is the total amount (in AUD$) requested from Amgen?
What is the total program / event budget? (in AUD$)?
Will it be acceptable if Amgen provides a donation for an amount less than requested above?
Yes  No
If no, please comment:
Please provide details on how the funds will be used.

Will the program/event be multi-sponsored?
Yes  No


Payee Information


Please provide the full legal name of the requesting institution / organisation.
Please provide the full legal address of the requesting institution / organisation
Address1
Address2
Suburb
State
Postcode
Is the requesting institution / organisation a not-for-profit or tax-exempt organisation?
Yes   No
If yes, enter the organisation's ABN:



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