By filling in this registration form, you agree that Roche Diagnostics Asia Pacific and its affiliates, including PT Roche Indonesia, may collect, use and disclose your personal data, as provided in this form, for the purpose of administering your registration for [insert description of Dialog], in accordance with the prevailing data privacy legislation in the Republic of Indonesia. Please visit our website at here (link to Privacy Policy page) for further contact details to, amongst other things, withdraw your consent to the collection, use or disclosure of your personal data.