Astellas Pharma Inc. will collect and record the personal information that you will submit including your full name, personal contact details, ethnicity data, and information about your diagnosis or condition, or the diagnosis or condition of the person you care for, to contact you about participating in future engagements with Astellas. Your information may be shared with other entities in the Astellas group of companies, including in the United States. Astellas has put in place appropriate contractual safeguards, as required by law. By clicking “I agree” below you expressly consent to our transfer of your personal information to overseas recipients, including to countries with data protection laws that may not be as protective as the country you live in. If you do not consent to the transfer, then you will not be able to provide your personal details in the Form.

If you share your experience providing care to another person whom you identify to us, or otherwise share personal information that relates to someone other than yourself, you acknowledge and agree that you are responsible for obtaining any consents or authorizations needed to disclose the individual’s information to Astellas.

IMPORTANT: Your consent is voluntarily, and you are under no obligation to consent. Even if you consent, you can subsequently withdraw consent at any time by completing this Form here (although this withdrawal of your consent will not affect any uses of your personal information prior to withdrawal). Astellas may be authorized by data protection laws to continue to process personal information in some circumstances. For example, we will continue to process personal information where we have a legal obligation to do so. Please note that if you do not consent, or if you subsequently withdraw consent, we will be unable to engage with you. To learn more about Astellas’ privacy practices and the rights you have under applicable laws, you may access our full Privacy Notice if you click here.

If you have any questions or concerns about our use of your personal information, then please contact us or our data protection officer using the following contact details: privacy@astellas.com.

By clicking “I agree” below, you expressly consent to Astellas, its global subsidiaries and affiliates, collecting, using, and transferring your personal information for the purposes described above.