11. I understand that I shall receive a signed copy of this summary statement. 
Patient 
Parent 
Physician 
Witness 
Date 
Time 
In case of questions or emergencies in reference to this protocol, please contact: 
St. Jude Children’s Research Hospital 
332 North Lauderdale 
Memphis, TN 38105 
Telephone: (901) 522-0300 
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