F rorn I 
DEUEL. GENETICS & MGLEC BIOL PHONE No. : 216 368 3590 
M8y. 28 1 993 l2l07Pfi P 
CONSENT FORM 
p 5. Effect of Episomc -Based Antisense cDNA Transcription of Insulin-Like Growth Factor-1 on 
Tumorigenicity of Human Brain Tumors 
Dr. Fenslermacher or Anthony has described to me what is going to be done, how it 
is going to be done and the risks, hazards and benefits involved, and will be 
available for questions at (216) 791-3800 exl. 5407 or 368-3388, 
I understand that my decision to participate or not to participate in this study will not alloi my usual 
health care. In the use of information generated from this study, my identity will remain anonymous. 1 
am aware that I may withdraw from this study at uuy time. I further understand that in the event of 
physical injury or illness occurring to me resulting from the research procedures, University Hospitals 
wiJ) not provide free medical care or compensation for lost wages. Further information with respect to 
this topic is available from the Office of the Chief of Staff. I understand that by signing this consent 
form, I do not waive airy of my legal rights nor docs it relieve investigators or suppliers of liability, but 
merely indicates that I have been informed about the research study hr which 1 am agreeing to 
participate. A copy of tills form is available to me upon request. 
Si gnature Age 
Date 
Parent or Guardian Signature (if subject is minor) ___ 
Witnessed by Date 
(Signature of Project Investigator) 
1RI3 
(4/89) 
Recombinant DNA Research, Volume 18 
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