By providing your name and other personal information above and clicking the "Submit" button below, you agree to permit Merck
and others working on behalf of Merck to use this information to provide you with information, resources, services, and communications
about MerckEngage as well as other condition-specific information and related treatment options via e-mail. Additionally,
your information may be used for market research purposes. At any time, you can request a copy of this permission and that
personal information about you be removed from the Merck contact list for MerckEngage by calling 888-776-8364. Unless you
change this selection sooner, your permission will expire 1 year after Merck no longer promotes products related to areas
you have elected to receive information regarding. By clicking "Submit," I am signing this form.