Community Champions

Nomination category

Nominee Details

Nominee first name

Nominee last name

Nominee email

Nominee phone

Nominator Details

Nominator first name

Nominator last name

Nominator email

Nominator phone

Reason for nomination (150-300 words)

I consent to the collection and use of my personal information in accordance with Gilead’s Privacy Statement below. I confirm that I have obtained the consent of the nominee:

to nominate them for a 2024 Community Champion award;
to disclose the personal information set out in this form to Gilead; and
for Gilead to use their personal information in accordance with Gilead’s Privacy Statement below.

Gilead’s Privacy Statement

Gilead Sciences Pty Ltd (ACN 072 611 708) and Gilead Sciences (NZ) (company number 1476178) (together “Gilead”) will collect and use your personal information to facilitate the 2024 Community Champion awards. Gilead may collect such personal information directly from you, or if you are a nominee, from the individual that nominated you for the award.

Gilead may disclose your personal information to service providers engaged by Gilead to assist with the Community Champion awards and relevant ancillary purposes. Gilead and its service providers store your personal information on servers in the USA, the United Kingdom and Ireland and any other countries listed in Gilead's Privacy Policy. Your personal information may also be accessed by personnel of Gilead's related bodies corporate, located in the U.S. and other countries outside of Australia and New Zealand, as set out in Gilead's Privacy Policy. A list of the countries in which Gilead has related bodies corporate can be found at www.gilead.com under “Global Operations”.

Information about how you may seek to access or correct your personal information held by Gilead can be found in Gilead's Privacy Policy. Gilead's Privacy Policy also contains information on how you may complain about breach of the Privacy Act and how Gilead will deal with such a complaint. If you have any queries about how Gilead handles your personal information, please write to our Privacy Officer at [email protected].