UCSD Project 93-41 8 
7/22/93 
CCTG 705 
Version 1.4 
has explained the study to me and has answered my questions. 
If I have other questions or research related problems I may reach Dr. Richard Haubrich 
at 543-8080. 
Participation in research is entirely voluntary. I may refuse to participate or withdraw at 
any time without jeopardy to the medical care I will receive at this institution. 
Research records will be kept confidential to the extent provided by law. Records of this 
research will not contain my name. Representatives from Viagene, Inc., or the FDA may 
look at these records to monitor safety. These research records or any publication 
resulting from the study will not use my name. 
I have received a copy of the consent document to keep and a copy of "The Experimental 
Subject’s Bill of Rights". 
I agree to participate. 
Subject’s Signature 
Date 
Witness 
Date 
[714] 
Recombinant DNA Research, Volume 18 
