Biodiversidade
Celgene Corporation
COORDINATING PRINCIPAL INVESTIGATOR SIGNATURE PAGE [include if applicable]
Signature of Coordinating Principal Investigator
dd/mm/yy
Printed Name of Coordinating Principal Investigator and Title Site Number________ By my signature, I agree to supervise and oversee the conduct of this study and to ensure its conduct is in compliance with the protocol, informed consent, IRB/IEC procedures, instructions from Celgene representatives, the Declaration of Helsinki, ICH Good Clinical Practices guidelines, and the applicable parts of the United States Code of Federal Regulations and local regulations governing the conduct of clinical studies.
Confidential and Proprietary
2
Amendment #1: 07 November 2008
Lenalidomide Protocol CC-5013-MM-020/IFM 07-01
Celgene Corporation
SITE PRINCIPAL INVESTIGATOR SIGNATURE PAGE
Signature of Site Principal Investigator
dd/mm/yy
Printed Name of Site Principal Investigator and Title Site Number________ By my signature, I agree to personally supervise the conduct of this study at my study site and to ensure its conduct is in compliance with the protocol, informed consent, IRB/EC procedures, instructions from Celgene representatives, the Declaration of Helsinki, ICH Good Clinical Practices guidelines, and the applicable parts of the United States Code of Federal Regulations and local regulations governing the conduct of clinical studies.
Confidential and Proprietary
3
Amendment #1: 07 November 2008
Lenalidomide Protocol CC-5013-MM-020/IFM 07-01
Celgene Corporation
1.
Table 1:
STUDY CONTACT INFORMATION
Celgene Emergency Contact Information
Name Address and Telephone Number Role in Study
Global Study Manager
Elvira Klissourska, PhD
Celgene International Sarl Route de Perreux 1 2017 – Boudry Switzerland Tel: + 41 32 7298432 Mobile: +41 795709820 E-mail: eklissourska@celgene.com Celgene International Sarl