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U.S. Department of Health and Human Services

Vaccines, Blood & Biologics

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Registration Form: Strategies to Address Hemolytic Complications of Immune Globulin Infusions

Registration Form

Public Workshop: Strategies to Address Hemolytic Complications of Immune Globulin Infusions

Lister Hill Center Auditorium
National Institutes of Health Campus
Building 38A
8600 Rockville Pike
Bethesda, MD 20894

January 28-29, 2014

 

PLEASE PRINT OR TYPE:

 

Name______________________________________________

Please circle: (MD, PhD, MS, MPH, RN) Other ____________

Title_______________________________________________

Affiliation (Firm Name)_________________________________

Address____________________________________________

City_______________________________________________

State_________________ Zip__________________________

Phone_________________ Fax________________________

E-mail_____________________________________________


E-mail or Fax this form by January 10, 2014 to:

Chris Nguyen
Email: CBERPublicEvents@fda.hhs.gov (Subject line: IG Hemolysis Workshop)
FAX: 301-827-3079

Center for Biologics Evaluation and Research (HFM-49)
Food and Drug Administration
1401 Rockville Pike, suite 200N
Rockville, MD 20852-1448
Phone: 301-827-2000