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Pandemic influenza planning advertisement

Please fill in the following contact details if you are interested in Business continuity information regarding pandemic influenza/and or antiviral stockpiling for your organisation.

Please check the box/boxes that apply
I am interested in business continuity planning for the threat of pandemic influenza
I am interested in obtaining pharmaceutical advice in the context of our business continuity plan
I would like to receive a free copy of the Survive guidelines (subject to availability)
Personal & Company information:

Title:
Surname:
Forename:

Company name:
Position held in organisation:
Industry type:
Address:

City:
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Work Tel:
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Does your company have a full medical professional:

Thank you for your interest in Roche.

By submitting this information I agree that a staff member at Roche may review the details that I have submitted and will contact me with regards to pandemic planning at my organisation. This information will not be used for any other purpose.