PROTOCOL THS 9A-002 
REVISED 05/24/94 
PAGE 6 of 6 
14, I may discuss any questions or problems during or after this study with Dr. 
Jack A. Roth at (713) 792-6932. In addition, I may discuss any problems I 
may have or any questions regarding my rights during or after this study 
with the Chairman or the Surveillance Committee at (713) 792-3220 and 
may in the event any problem arises during this clinical research contact the 
parties named above. 
Based upon the above, I consent to participate in the research and have received a 
copy of the consent form. 
I have discussed this clinical research study with the Participant and/or his or her 
authorized representative using a language which is understandable and 
appropriate. I believe that I have fully informed this participant of the nature of 
this study and its possible benefits and risks, and I believe the participant 
understood this explanation. 
CONSENT 
DATE 
SIGNATURE OF PARTICIPANT 
WITNESS OTHER THAN PHYSICIAN 
OR INVESTIGATOR 
SIGNATURE OF PERSON 
RESPONSIBLE & RELATIONSHIP 
PHYSICIAN/INVESTIGATOR 
Recombinant DNA Research, Volume 19 
[609] 
