Country: Thailand
Language: English


What are your personal details?

(Field with * is required)

What is your job?

(Field with * is required)

What’s your primary work address?

(Field with * is required)

What are your contact details?

(Field with * is required)
Roche may contact you via your mobile number.
Mobile number must start with 0 and have 10 digits without spaces or any special characters

What is your email?

(Field with * is required)
This will be your login email. You will receive a confirmation link at this email.

Choose a password

(Field with * is required)
Password must have at least 8 characters, 1 number, 1 uppercase letter, 1 lowercase letter, not more than 4 consecutive identical characters, not contain a 5 character or more portion of the email address.

Password should have:

  • 1 number
  • 1 lowercase letter
  • Minimum 8 characters
  • Non-english characters
  • 1 UPPERCASE letter
  • Not containing #@~{}[]|_\

Confirmation matches the password

Legal Information

(Checkbox with * is required)