WPC  zŤ7qqɈvԳd5>I\R>[nRG|Ɂ*=%T`+6al:E]U^)w#h%Ew5q铮K w~h hk^ĸ.vvrfIBWj;e Lzk|-PsunrB`"^ fyT }&Փ`7G+r,U㊼e{x-[mrlY|?"0%.j_/Ė6iۀZdLq|jAh{>W9 sodFlq;8Nם$4RkfտcmH*؛0 adP1{ê=42N[2#6/*H: ]_lq2TX" L&Od ϋF3Ҁ Ps[#!U: %U 0([^ w"4 mfa+ 0D. e r N| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | B~ HP LaserJet 4/4M PostScript0,cAZ"Arial RegularX($-**{DE)*Y3|xU4TABLE A ! )  _àXX.bRC:\1wpdocs\MACS\FORMS\SpecimenUseForm.wpdbC:\1wpdocs\MACS\FORMS\SpecimenUseForm.wpd/  00?(#May10,2000#XXà,#(3$ !    d !  _X @) ) a~XX RestrictedUseofMACSSpecimens #XXa~`#Ԉ  ThisformistobecompletedforMACSparticipantsthathaverefusedconsentforstoredspecimenstobeusedtoestablishacellline,forpossiblecommercialvalue,or v forotherreasonsthatmayevolveoverthecourseofthestudy.Aseparateformshouldbecompletedforeachparticipantthatdeniesconsent.SubmittheformtoCAMACS(4109557587fax).Therepositorydatabasefileswillbeflaggedimmediatelytoreflectthisinformation.IDNumber:0 ` 0 ` (#` (#_______________r  (# (# Date:0  0` (#(#______/______/____________>` (#` (# Ѐ0  0` (#(#m_mMMm_Ԁddyyyy$t` (#` (# ThefollowingspecimentypesfromthisparticipantshouldNOTbedistributed:[markallthatapply]  * ddd Xdd Xdd X(#(#,A dd ,dd ,dd +   : 1.Cellstoestablishacellline___  j  -#4 -ForResearchUse 4  '  " 'ForCommercialUse 4!   "" 2.Plasma  #% ___ 'D"&" '___ D"'" 3.Serum  p&!* ___ '%g +" '___ %g ," 4.Cells(_PBMCs_)  C)$/ ___ '':#0" '___ ':#1" 5.Existingcelllines  ,f'4 ___ '* &5" '___"* &6"  "