ACKNOWLEDGMENT OF SUPPORT FOR CONTINUING EDUCATION OF HEALTHCARE PROFESSIONAL
This is to acknowledge that my attendance to Laban Community on March 25, 2022 is support for my continuing medical education (CME), provided by Wyeth Philippines, Inc. This continuing medical education activity will assist me in updating my scientific and medical knowledge and advance my professional capabilities that will lead to quality care of my patients. *
I certify that there is no link between this support and my use/ prescription/ recommendation of products within the scope of WHO International Code of Marketing of Breastmilk Substitutes (WHO Code) and Executive Order No. 51 and its Revised Implementing Rules and Regulations (Philippine National Milk Code). *
I also acknowledge my responsibility under Article 7.5 of the WHO Code, that manufacturers and distributors of products within the scope of this Code should disclose to the institution to which a recipient healthcare worker is affiliated any contribution made to him/her or on his/her behalf for fellowships, study tours, research grants, attendance at professional conferences or the like. Similar disclosures should be made by the recipient. *
PRIVACY CONSENT
This Privacy Consent form explains what personal information Wyeth Philippines, Inc. (WPI/ Wyeth Nutrition), PMII and Subliminal. (the “Organizers”) will process and collect from you, and the purpose for such processing and collection. Your information will be processed in compliance with Republic Act No. 10173 (the “Data Privacy Act”) and its implementing rules and regulations. The information processed is a pre-requisite to your participation in the LABAN COMMUNITY (the “Event”) and shall be for purposes of ensuring the orderly and organized holding of the Event. The Organizers will collect and process your: a.) name, b.) PRC number, c.) email address, as well as any other information, necessary for the Organizers’ fulfillment of its lined-up activities for the Event. Processing is hereby understood to include any operation or any set of operations performed upon personal information including, but not limited to, the collection, recording, organization, storage, sharing, updating or modification, retrieval, consultation, use, consolidation, blocking, erasure or destruction of data. Processing would include both manual and automated handling of personal information and storage and data transfers using various means including but not limited to physical methods as well as electronic via information and communications systems employed by the Organizers and their representatives.
The information that you will share will be used for the purpose of holding the Event, implementing the activities planned for it, (including the continuing medical education seminar as part of the Event), as well as your participation in the Organizers’ future marketing activities. This information shall be kept confidential at all times and only authorized personnel of the Organizers will have access to your information. We implement reasonable and appropriate physical, technical, and organizational measures to prevent the loss, destruction, misuse or alteration of your personal information. By providing your information, you hereby warrant that you understand your rights and obligations under the Data Privacy Act and its Implementing Rules and Regulations and that you shall hold the Organizers free and harmless from any claim for liability or damages which may arise as a result of the processing and collection of your information. Should you have further questions on your information, you may send your queries to DataProtectionOffice@wyethnutrition.com.
I agree to provide limited personal information using this form for the purpose of registration and assessment as part of the continuing medical education provided by Wyeth Nutrition.
I give my consent to the Organizers to contact/ notify me for marketing activities related to my participation in the Event.
I acknowledge that my consent is given voluntarily and that I may withdraw it at any time.
Before joining this Event, I understand and confirm that (a) the articles, modules and any other information or materials to be provided by Wyeth Philippines Inc. are intended solely for my exclusive use in my capacity as a Healthcare Professional and (b) I will not share these modules and any other information or materials provided to me. *
WAIVER AND RELEASE FROM LIABILITY
I hereby voluntarily and with full knowledge release, waive and forever discharge any and all liability, claims, and demands of whatever kind or nature against the Organizers and their affiliated partners and sponsors, including in each case, without limitation, their directors, officers, employees, volunteers, and agents of the Organizers, either in law or in equity, to the fullest extent permissible by law, including but not limited to damages or losses caused by the negligence, fault or conduct of any kind on the part of the Organizers, including but not limited to death, bodily injury, illness, economic loss or out of pocket expenses, or loss or damage to property, which I, my heirs, assignees, next of kin and/or legally appointed or designated representatives, may have or which may hereinafter accrue on my behalf, which arise or may hereafter arise for my participation in the Event.
CONFIRMATION & REGISTRATION
By registering my details, I confirm to have read and understood the Acknowledgement of CME Support, Privacy Notice and Consent/Waiver Form.