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Resources delivered to you

Sign up to receive tools and support that can guide you on your severe active GPA or MPA journey, and help you make decisions with your doctor.

Receive important disease and treatment information

This digital educational brochure can help you understand how severe active GPA or MPA can affect your body and inform you of potential treatment options.

Access a helpful Doctor Discussion Guide

This digital Doctor Discussion Guide can help you talk with your doctor about your GPA or MPA symptoms, how they are impacting you, and your treatment goals.

Request a hospital emergency readiness kit

Advocate for yourself with this Hospital Emergency Advocacy & Treatment (HEAT) Kit™ supplied by the Eosinophilic Rare Disease Cooperative (ERDC). This kit can help you organize important information about your health for communicating with your medical team during an emergency hospital visit.

Program Eligibility

Date of Birth

You must be 18 years or older to complete enrollment online.

Please select your date of birth

Would you like to be mailed a free Hospital Emergency Advocacy & Treatment (HEAT) Kit™ from the ERDC (HEAT Kit™ quantities are limited while supplies last)?

Your mailing address will only be used to deliver the HEAT Kit™ from the ERDC.

Yes

No

Personal Information

First Name

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Last Name

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Address Line 1

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Address Line 2 (Optional)

City

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State

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Gender

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Patient Authorization and Consent

Step 1 of 3

*Please make a selection

Consent to Health Data Collection & Processing for Marketing Purposes

I consent to Amgen collecting and processing my Health Data for the following purposes:

To conduct marketing activities, including market research activities, and to communicate with me regarding products and services that may be of interest to me.

Amgen uses the following for marketing purposes:

Health Data – my name, gender, date of birth, contact information and information relating to my health condition or treatment.

I understand that Amgen is seeking my consent to collect and process my Health Data to market products and services to me and that I do not have to give consent to the collection and processing of my Health Data for marketing purposes in order to participate in the ANCA Resource Hub program. I also understand that Amgen will not sell my Health Data to third parties. If I consent to the collection and processing of my Health Data for marketing purposes, I agree that Amgen may contact me for marketing purposes. Finally, I understand that I may withdraw my consent to the collection and processing of my Health Data for marketing purposes at any time using one of the methods listed in the Additional Disclosures section below.

I consent to the collection and processing of my Health Data for marketing purposes
I do not consent to the collection and processing of my Health Data for marketing purposes

If you do not consent to the collection and processing of your health data for marketing purposes, you will not be able to receive marketing communications from Amgen. If you want to receive marketing communications from Amgen, select “I consent to the collection and processing of my Health Data for marketing purposes”

Step 2 of 3

*Please make a selection

Consent to Health Data Disclosure for Marketing Purposes

I consent to Amgen disclosing my Health Data to its data processors, contractors, and business partners for the following purposes:

To conduct marketing activities, including market research activities, and to communicate with me regarding products and services that may be of interest to me.

If I provide my consent, Amgen will disclose the following for such purposes:

Health Data – my name, gender, date of birth, contact information and information relating to my health condition or treatment.

I understand that Amgen is seeking my consent to disclose my Health Data to its data processors, contractors, and business partners to market products and services to me and that I do not have to give consent to disclosure of my Health Data for marketing purposes in order to participate in ANCA Resource Hub. I also understand that Amgen will not sell my Health Data to third parties. Finally, I understand that I may withdraw my consent to the disclosure of my Health Data for marketing purposes at any time using one of the methods listed in the Additional Disclosures section below.

I consent to the disclosure of my Health Data for marketing purposes
I do not consent to the disclosure of my Health Data for marketing purposes

If you do not consent to the disclosure of your health data for marketing purposes, you will not be able to receive marketing communications from Amgen. If you want to receive marketing communications from Amgen, select “I consent to the disclosure of my Health Data for marketing purposes”

Step 3 of 3

*Please make a selection

Telephone Consumer Protection Act

By providing my phone number and selecting “I agree”, I consent to Amgen calling and texting me at the phone number(s) I have provided with promotional communications relating to Amgen products and services and/or my condition or treatment. Amgen may use automatic dialing machines or artificial or prerecorded messages to contact me and may leave a voicemail or SMS/text message (standard text messaging rates may apply). SMS/text messages from ANCA Resource Hub will be sent to the mobile phone number provided. Reply HELP for help or STOP to cancel. Please click to read the Mobile Terms and Conditions and Privacy Statement. I understand that I am not required to provide this consent as a condition of purchasing any goods or services.

I Agree
I Disagree

If you select “I Disagree” for the Telephone Consumer Protection Act, you will not be able to receive any promotional (e.g. marketing) voicemail or SMS/text message communication from Amgen for this program. If you want to receive promotional voicemail or SMS/text messages from Amgen for this program, select “I Agree” consent for the Telephone Consumer Protection Act.

Additional Disclosures

I understand that participation in the ANCA Resource Hub program and, if I have consented, receipt of marketing communications are optional services at no cost to me. The consent(s) above in no way affects my right to obtain any medications and I do not have to provide consent to be able to receive any medications. To obtain a copy of the consent(s) above or to withdraw my consent to collection, processing, and/or disclosure of my Health Data for any of the above purposes to which I have consented, I can contact Amgen by visiting www.amgen.com/DataSubjectRights. For more information about Amgen’s privacy practices, Amgen’s Privacy Statement can be found at https://www.amgen.com/privacy.

Thank you!

We received your information. You'll be receiving additional tools and resources via email and text shortly. Your requested HEAT Kit^TM will arrive by mail.

Thank you!

We received your information. You'll be receiving additional tools and resources shortly via email and text.

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Please call us at Anca101 to complete your request.

Looking for a doctor?

Visit Healthgrades’ website to find a specialist near you who may treat GPA or MPA.

Healthgrades is not owned or controlled by Amgen, and Amgen is not responsible for their content. However, you may find them helpful.

Find a doctor

Online support groups

People with vasculitis and their loved ones can find information about these and other support groups offered through the Vasculitis Foundation (VF) and their affiliated groups.

The Vasculitis Foundation organization is not owned or controlled by Amgen, and Amgen is not responsible for their content. However, you may find them helpful.

Vasculitis Voices online chat community

This is a place where caregivers and loved ones can find connections, support, and information in an online chat community.

VF weekly support meetings

This meeting is led by a licensed clinical social worker and encourages community building among people with vasculitis. Family members are also invited to attend.

VF Young Adult support meeting

This meeting is for patients ages 18-30 to connect with and get support from other young adults who are also living with vasculitis.

Find more support groups

Do you wish to continue?

Resources delivered to you

Receive important disease and treatment information

Access a helpful Doctor Discussion Guide

Request a hospital emergency readiness kit

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Program Eligibility

Personal Information

Patient Authorization and Consent

Additional Disclosures

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Looking for a doctor?

Online support groups

Vasculitis Voices online chat community

VF weekly support meetings

VF Young Adult support meeting

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