Ninu 1S:SP 
FPnn r,FN7YMF P. I DTHFRPP 
tfi qi T ^idqFqp~q 
PQRF.Fttl 
SHS Appiuval Stamp Patient ID ^rsmp 
Massachusetts General Hocpital 
MEDICAL RESEARCH CUMSEUT FORM, Page Li 
Title of Project: Adenovi rus -Mediated Gene Transfer for Cvstic 
Fibrosis: Safety of Single Lobar Administration in the Lunu 
Principal Investigator: Allen Lauev . M.D. 
SUBJECT ADVOCATE STATEMENT FOR CONSENT FORM 
I have discussed the research procedures and the potential risks 
and benefits with the subject. I am satisfied that the subject's 
consent is based on adequate information and is voluntary. 
Subject Advocate Signature 
Date 
Recombinant DNA Research, Volume 20 
[591] 
