10. ASSURANCE FORM 



Before cells can be shipped from the Genetic Mutant Cell 

 Repository the recipient institution must submit a purchase 

 order number and agree to the limitations listed below. This 

 agreement must be renewed annually. Please sign and return 

 originial to the Institute for Medical Research, Copewood 

 Street, Camden, New Jersey 08103. 



ASSURANCE 

 As purchaser of cell cultures from the Genetic Mutant Cell 

 Repository we agree that such cells, their progeny, or deriva- 

 tives will not be used in human experimentation. It is further 

 agreed that if such use is planned, the purchaser will first ob- 

 tain prior written approval of the Project Officer, NOl-GM-6-2119 , 

 National Institute of General Medical Sciences. 



It is further agreed that cell cultures obtained from the 

 Genetic Mutant Cell Repository will not be resold, but they may 

 be replicated by a third party for the original purchaser. The 

 third party shall not be allowed to resell other than to the 

 original purchaser furnishing the material for replication and 

 the third party shall not use such cells for human experimen- 

 tation. 



Name of Institution Name of Principal Investigator Date 



Signature of Authorized Signature of Principal Date 



Official Investigator 



