You are: Please Select TV Station Radio Station Physician Flu Surveillance site Health-related website Other   (REQUIRED)

By filling out this form and placing the FluSTAR local activity reports on your Web page(s), you may not distribute, transmit, resell, broadcast, or otherwise use this information for any purpose whatsoever, beyond the intended display on your internet site, without giving specific credit to flustar.com.

If you are a television or radio broadcast station, placing the code for the one-day flu report on your Web site does grant you permission to use this information in a broadcast format on radio, television or cable, without the prior written permission of FluSTAR.com, provided you give credit during the broadcast use to flustar.com. We hereby grant to you a non-exclusive, non-transferable sublicense to display, and you agree to display, our trade names, trademarks, service names and service marks (our "Marks") on pages within your website to present the flu activity reports, and to establish the link to the co-branded activity report pages.

We reserve the right to change or alter any segment of the FluSTAR.com web site without notice. We may terminate the licenses granted herein at any time with ten days prior notice, or immediately upon a determination by us that you have breached any of the terms and conditions contained in this agreement. Roche Laboratories Inc. is the sole owner of the Content including, but not limited to, all copyrights, trademarks, trade names, service marks and other proprietary rights. Upon termination of your rights under this agreement, you will immediately remove all links to the site that you may have established.

All Content is provided "AS IS/WHERE IS". We make no representations or warranties, implied or otherwise, of any kind or nature with respect to the Content, including the accuracy of any of the information contained within the Content, and we disclaim the same. We specifically disclaim any representation or warranty regarding the accuracy or reliability of any flu activity level.

In no event will we be liable to you, whether in contract or in tort or under any other legal theory (including strict liability) for any damages, including, but without limitation, direct or indirect, special, incidental, punitive, exemplary, consequential, lost profits or revenues or similar damages arising out of or in connection with this agreement or your use of the FluSTAR.com - flu activity level on your Web site.

You may not assign these rights and licenses granted herein without our prior written consent. The validity and effect of this agreement shall be governed by the laws of the State of Pennsylvania, without regard to its conflicts of law rules. All claims relating to this agreement will be resolved in Pennsylvania, and you agree to that venue and the exclusive jurisdiction of Pennsylvania courts. This agreement contains the entire agreement between us and you relating to the subject matter hereof, and cannot be modified or terminated except in a writing duly executed by both parties.

Submitting this form does not constitute an agreement on our part to distrubute the flu activity reports to your Web site; each affiliate must be approved individually. The information contained in the flu activity reports is copyright FluSTAR.com and Roche Laboratories Inc. FuSTAR and FluSTAR.com are trademarks of Roche Laboratories Inc.

Yes, I understand and agree to these terms and conditions.

Once your site is approved, you'll receive an e-mail that will give you a unique Affiliate ID, and direct you to a private page on FluSTAR.com showing you how the display code is implemented. These examples should enable your web staff to place the flu reports on your Web site in just a few minutes!