10. I understand that if I have further questions regarding this study/ treatment or 
concern about injury from this study/treatment, I can contact Drs. Robert Krance, 
Malcolm Brenner or Helen Heslop at (901) 522-0300. 
11. I understand that further information regarding my/my child's rights as a research 
participant can be obtained by contacting the Chairman of the Clinical Trials Review 
Committee, at (901) 522-0300. 
12. I understand that I can receive a signed copy of this summary statement and a 
separate detailed treatment plan, if I wish. 
Patient 
Investigator 
Date 
Parent or Guardian 
Witness 
Time 
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Recombinant DNA Research, Volume 17 
