{"id":1346,"date":"2023-02-24T14:31:31","date_gmt":"2023-02-24T14:31:31","guid":{"rendered":"https:\/\/pkudsepatient-dev-001.azurewebsites.net\/en-us\/?page_id=1346"},"modified":"2024-02-15T12:14:38","modified_gmt":"2024-02-15T12:14:38","slug":"contact-a-rep","status":"publish","type":"page","link":"https:\/\/pku.biomarin.com\/en-us\/contact-a-rep\/","title":{"rendered":"Contact a rep"},"content":{"rendered":"<div id=\"acf-block-63f8caf8e6abc\" class=\"hero\">\n            <div class=\"hero-background-image hero-background-image-desktop\" style=\"background-image: url(https:\/\/pku.biomarin.com\/en-us\/wp-content\/uploads\/sites\/7\/2023\/03\/Group-110-scaled-e1678703759379-2000x435.jpg);\"><\/div>\n\t    <div class=\"hero-background-image hero-background-image-mobile\" style=\"background-image: url(https:\/\/pku.biomarin.com\/en-us\/wp-content\/uploads\/sites\/7\/2023\/02\/pku-balloon-hero-mobile-830x800.jpg);\"><\/div>\n    \t<div class=\"overlay\"><\/div>\n\t<div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t\t<div class=\"hero-content\">\n\t\t\t    \t\t\t\t\t\t\t\t\t\t\t\t    <h1>Connect with us\n<\/h1>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n<div id=\"acf-block-63fcbb5e6a46c\" class=\"block contact-rep-form\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n            <div class=\"above-form-copy\">\n                <h2>Connect with a local BioMarin representative<\/h2>\n<p>Complete the form below to be contacted by a BioMarin representative for information about managing PKU.<\/p>\n            <\/div>\n            <div class=\"block form-box\">\n                <p>(* indicates a required field.)<\/p>\n                <form id=\"contact-rep\" name=\"Connect with a local BioMarin representative\">\n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"first-name\">First name<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"first-name\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your first name\">\n                        <\/div>\n\n                        <div class=\"form-item\">\n                            <label for=\"last-name\">Last name<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"last-name\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your last name\">\n                        <\/div>\n                    <\/div>\n\n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"email\">Email<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"email\" type=\"email\" required\n                            data-pristine-required-message=\"Please enter your email address\">\n                        <\/div>\n\n                        <div class=\"form-item\">\n                            <label for=\"phone-number\">Phone number<\/label>\n                            <input class=\"text\" id=\"phone-number\" type=\"text\" data-pristine-required-message=\"Please enter your phone number\" required>\n                        <\/div>\n                    <\/div>\n\n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"dob-day\">Date of birth<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"dob\" type=\"text\" placeholder=\"mm\/dd\/yyyy\" required\n                            data-pristine-required-message=\"Please enter your date of birth\">\n\n                                                    <\/div>\n\n                        <div class=\"form-item\">\n                            <label for=\"zip-code\">US postal code<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"zip-code\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your postal code\"\n                            data-pristine-pattern-message=\"Please enter a valid postal code\"\n                            data-pristine-pattern=\"\/^\\d{5}(-\\d{4})?$\/i\">\n                        <\/div>\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"contact-type\">What best describes you?<span class=\"required\">*<\/span><\/label>\n                        <select class=\"text\" id=\"contact-type\" required\n                        data-pristine-required-message=\"Please select an option\">\n                            <option value=\"\">Please select an option<\/option>\n                            <option value=\"Patient\">I have PKU<\/option>\n                            <option value=\"Caregiver\">I support someone with PKU<\/option>\n                        <\/select>\n                    <\/div>\n\n                    <div class=\"form-item check-item\">\n                        <input type=\"checkbox\" id=\"accept-contact-rep\" name=\"accept-contact-rep\">\n                        <label for=\"accept-contact-rep\">I would like to be connected with a local BioMarin representative to learn more about local events and resources about PKU.<\/label>\n                    <\/div>\n\n                    <div class=\"form-item check-item\">\n                        <input type=\"checkbox\" id=\"accept-ts-cs\" name=\"accept-ts-cs\" required\n                        data-pristine-required-message=\"Please select that you have read and agree to the Terms &amp; Conditions and Privacy Policy before submitting this form\">\n                        <label for=\"accept-ts-cs\">By checking the box to the left and clicking Submit below, I confirm I am at least 18 years old; and confirm I agree to BioMarin\u2019s <a href=\"https:\/\/www.biomarin.com\/data-privacy-center\/\" target=\"_blank\">Privacy Policy and CCPA Notice<\/a> and <a href=\"https:\/\/medinfoterms.com\/\" target=\"_blank\">Terms of Use<\/a>; consent to BioMarin, its successors, agents, and\/or assigns using the email address I have provided to keep me informed about updates about news and developments about PKU; and confirm I understand these communications\/materials may contain information that markets or advertises BioMarin products, goods, or services.<span class=\"required\">*<\/span><\/label>\n                    <\/div>\n\n                    <div class=\"form-item check-item\">\n                        <input type=\"checkbox\" id=\"accept-marketing\" name=\"accept-marketing\"\n                        data-pristine-required-message=\"Please agree to the terms of use\">\n                        <label for=\"accept-marketing\">By checking the box to the left and clicking \u201cSubmit\u201d below, I consent to BioMarin, its successors, agents, and\/or assigns using the phone number I have provided to phone and\/or text me with communications\/messages that contain information marketing BioMarin\u2019s products, goods, or services, including via use of an automatic telephone dialing system; and confirm I understand I am not required to provide my consent as a condition of purchasing or renting any products, goods, or services.<\/label>\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <input type=\"submit\" class=\"button\" value=\"Submit\">\n                    <\/div>\n                <\/form>\n                <form id=\"mktoForm_3315\" style=\"display:none;\"><\/form>\n            <\/div>\n\n            <div class=\"block form-success-confirmation\" style=\"display:none;\">\n                                    <h3>Thank you!<\/h3>\n<p>We&#8217;ll be in touch soon with additional information.<\/p>\n                                            <\/div>\n        <\/div>\n    <\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Contact a Representative | PKU - Phenylketonuria<\/title>\n<meta name=\"description\" content=\"Learn more about PKU through resources and personalized support. 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