Zogenix

Zogenix International Limited – Opt-in collection

Zogenix has received your contact details from independent sources and retains your data for the time necessary to pursue legitimate business objectives and comply with the law. To meet those purposes, your personal data may be transferred to Zogenix’s services providers, Zogenix Affiliates and public authorities.

You can view Zogenix privacy policy and obtain information on your rights relating to Zogenix’ use of your personal data here or sending us an e-mail to EUDataPrivacy@Zogenix.com

Fill the form below if you would like to give your consent to receive scientific and/or marketing information from Zogenix International Limited through various channels. Providing such data is voluntary and you can amend your preferences or revoke your consent at any time by sending us an e-mail to EUDataPrivacy@Zogenix.com.

Completing this form will only require a couple of minutes.

Full Name

Country

Opt-In (please scroll to complete all boxes for Email, Phone and SMS even if not required). Please provide a Yes/No choice for both rows.

	Via Email	Via Phone	Via SMS/Text
Do you want to receive information relating to Zogenix’s licensed products and invitations to promotional events?	Yes No You must select at least 1 option!	Yes No You must select at least 1 option!	Yes No You must select at least 1 option!
Do you want to receive scientific information and invitations to Medical Educational events?	Yes No You must select at least 1 option!	Yes No You must select at least 1 option!	Yes No You must select at least 1 option!

For this, we need you to provide us/confirm your:

Phone number

	Country Calling Code	Phone number
Phone number	Please choose a Country Calling Code	Please insert the phone number!

Zogenix International Limited – Opt-in collection

Do you want to receive information relating to Zogenix’s licensed products and invitations to promotional events?

Do you want to receive scientific information and invitations to Medical Educational events?

For this, we need you to provide us/confirm your:

Phone number

Do you want to receive information relating to
Zogenix’s licensed products and invitations
to promotional events?

Do you want to receive scientific information and
invitations to Medical Educational events?