10. I understand that if I have further questions regarding this study/treatment or concern 
about injury from this study/treatment, I can contact Dr. Joseph Mirro or Dr. 
Malcolm Brenner 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 
Parent or Guardian 
Investigator 
Witness 
Date 
[536] 
Recombinant DNA Research, Volume 14 
