22 
Illustration 
NAME OF INSTITUTION 
MEMORANDUM OF UNDERSTANDING AND AGREEMENT 
Application/Grant Number (if 
applicable) 
a. Description 
Investigator's Telephone 
Number 
(To be supplied) 
b. Assessment of Levels of Physical and Biological Containment 
(To be supplied) 
c. Information on Health Surveillance 
(To be supplied) 
d. I agree to conply with the NIH requirements pertaining to shipment 
and transfer of recombinant DNA materials. I am familiar with and 
agree to abide by the provisions of the current NIH Guidelines and 
other specific NIH instructions pertaining to the preposed project. 
The information above is accurate and complete. 
Principal Investigator Date 
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