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Request a Brochure and Application On-Line

Patients/Consumers:
In order to provide you with a brochure and application for the program, you must be a resident of the United States, Puerto Rico, Guam, or the US Virgin Islands. Although people of all ages, if eligible, can participate in the program, the information can only be sent to persons 18 years of age or older.

For more information about how Merck protects personal information about you, please read our Internet Privacy Policy and Privacy Commitment for US patients, consumers, and caregivers.


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