SIGNATURES BEGIN ON NEXT PAGE. The Parties have executed this Agreement by their respective duly authorized representatives on the day and year below. Any communication or notice to be given shall be forwarded in writing to the respective addresses listed below. FOR PROVIDER _____________________________________ __________________ Xxxxx Xxxx, MBA Date Technology Development Coordinator Division of Medications Development _____________________________________ Xxxx X. Xxxxxx, Ph.D. Acting Director, Division of Medications Development NIAAA Mailing Address for Notices: NIAAA Xxxxx Xxxx 0000 Xxxxxxx Xxxx, 0000 Xxxxxxxx, XX 00000 (000) 000-0000 xxxxx0@xxxx.xxx.xxx FOR RECIPIENT: ____________________________________ __________________ (Signature of Authorized Representative) Date Name Title Mailing Address for Notices: Email: Phone: RECIPIENT’s INVESTIGATOR: I have read and understood the terms and conditions of this Agreement and I will abide by them in the receipt and use of this Clinical Data. _____________________________________ __________________ Name: Date Address: Email: Phone:
Appears in 4 contracts
Samples: Data Transfer Agreement, Data Transfer Agreement, Data Transfer Agreement
