By submitting this form, I confirm I am a US Eyecare Professional and authorize Apellis Pharmaceuticals, Inc., its affiliates and their
representatives, agents, contractors, and companies working with Apellis (collectively,
“Apellis”), to contact me by mail, email, telephone, and text messages for marketing purposes or
to otherwise provide me with information about Apellis products, services, and programs or other
topics of interest; conduct market research and/or data analyses; or otherwise ask me about my experience with or
thoughts about such topics. I understand and agree that any information that I provide may be
used by Apellis to help develop new products, services, and programs.