Subject’s Statement 
I agree to this study and to the conditions outlined in the Basic Oncology Consent Form which I have 
read and signed. I have had an opportunity to ask questions of the physicians, including questions 
about risks, benefits and alternatives to treatment. These questions have been answered to my 
satisfaction. I understand future questions I may have about the research will be answered by one of 
the investigators listed above and that any questions I have about my rights as a research subject will be 
answered by the person identified above. No promises or guarantees have been made regarding the 
anticipated outcome of any tests or procedures. I am aware that I and/or my insurance carrier is 
responsible for the costs incurred in the therapy provided, including adverse effects. I give permission 
for my medical records to be available to physicians and personnel for this study at the University of 
Washington and the Fred Hutchinson Cancer Research Center, as well as the Food and Drug 
Administration and Amgen Corporation and the National Institutes of Health. I acknowledge that I 
will receive a signed copy of this consent form. 
Patient 
/Date 
Witness 
/Date 
Parent/legal guardian /Date Other parent/legal guardian /Date 
[for patients < 18 years old] [if reasonably available] 
#650 5/9/91 
Copies to: Patient 
Medical Records 
Research file 
Recombinant DNA Research, Volume 16 
[357] 
