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26. Signatures

 As a representative of this study, I hav explained to the participant th purposL4 the
 procedures, the possie benets, and ihe risks of his search study; the alternatives to being
 in ihe study, and how the pnrticipdan's proicled hr lrh inrormnilon wil be collected used and
 disclosed:




 Signacl of Person Obnining Consern and Authcriarmon Date



 You have been informed about thi study's purpose, pocedres, possible benefits, and risks;
 the alternatives to beirg n he study. and how your protected hcnhh infomnlion wifl be
 covected. used and disclosed. You hImc recc. cd a copy of his Form. You have been given
 the opportunity to ask quer ians before you sign, and you have been told that you cn ask other
 questions at any tmne.

 You olunrilyarn agree co parikipate in this sudy You herchy aulhorize he colBection, use and
 Lisclosure ofyaur proiecied thelrh unformalian us d-cribcd ir setIonm. 14-24 above, By
 signing this f you are not tiiving any of your legal rngrh;




 Signature ofPerson Consening and Aulhorizing Date


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