By clicking this box, I agree to the Terms & Conditions of Acceptance for Specimen Collection Kits stipulated by Amgen.

These Terms & Conditions of Acceptance shall apply in the event you (as a licensed prescriber) accept receipt of one or more Specimen Collection Kits from or on behalf of Amgen. Your acceptance of one or more such kits shall indicate that you will adhere to all of the following terms and conditions:

1. The Specimen Collection Kits will be used only upon the order of a licensed prescriber.

2. The Specimen Collection Kits will be used at no cost to patients. To be clear, neither you nor anyone else will sell or otherwise charge for the products or services associated with the Specimen Collection Kits.

3. Neither you nor anyone else will seek reimbursement from any third-party payor for the contents of the Specimen Collection Kit, or for the services rendered when using the Specimen Collection Kit. To be clear, neither private payors nor federal or state healthcare programs will be billed for any products or services associated with the Specimen Collection Kit.

I understand I am giving Amgen, its affiliates, subsidiaries and business partners permission to use and disclose the personal information provided in this registration form, as described in this authorization. I understand that the information I am providing may be used by Amgen to provide me with health and product information and related services concerning health conditions and treatments, and that Amgen will treat my information in accordance with its Privacy Policy. I agree that this authorization will expire ten (10) years from the date submitted, or until I withdraw my participation in the program. I acknowledge that I am submitting this form voluntarily, and that I am at least 18 years of age.