Risk Mitigation Strategies to Address Potential Procoagulant Activity in Immune Globulin Products Registration Form

The Universities at Shady Grove Conference Center
Building II, Multipurpose Room
9630 Gudelsky Drive
Rockville, MD 20850

May 17-18, 2011

(NO REGISTRATION FEE)

PLEASE PRINT OR TYPE:

Name______________________________________________
Please circle: (MD, PhD, MS, MPH, RN) Other____________
Title_______________________________________________
Affiliation__________________________________________
Address____________________________________________
City_______________________________________________
State_________________  Zip__________________________
Phone_________________  Fax________________________
E-mail_____________________________________________
 

Mail, fax or e-mail this form by April 26, 2011 to:

Rhonda Dawson, Program Coordinator
Food and Drug Administration
Center for Biologics Evaluation and Research
Office of Blood Research and Review
1401 Rockville Pike, HFM-302
Rockville, MD 20852
Phone: 301-827-6129
Fax: 301-827-2843
e-mail: rhonda.dawson@fda.hhs.gov