Permission to include name on Open Letter

[Guest guest]

I will NOT release the information provided to me except under a duly

processed and delivered court order orginating in a juridiction having

control over me.

I WILL include your name as a signatory without contact information.

I WILL provide a final copy to each person prior to sending for proof

reading and an option to withdraw as a signatory.

To have your name included fax to my home 214-353-9122 a permission

release stating the following:

I grant J. DiBona, M.D. permission to include my full name in

the " Open Letter to All Companies Offering EtG Testing " . No other

permissions are granted or implied.

Your signature

Your name

Your address

Your telephone number

Your email

[Guest guest]

Hi Dan,

I finally was able to fax you my consent letter, to your " e-fax, " so I hope it

went through,

let me know if you don't get it...

Thanks again for your hard work and eloquent professionalism (with a real edge

in there

too!).

Amy

>

> I will NOT release the information provided to me except under a duly

> processed and delivered court order orginating in a juridiction having

> control over me.

>

> I WILL include your name as a signatory without contact information.

> I WILL provide a final copy to each person prior to sending for proof

> reading and an option to withdraw as a signatory.

>

> To have your name included fax to my home 214-353-9122 a permission

> release stating the following:

>

> I grant J. DiBona, M.D. permission to include my full name in

> the " Open Letter to All Companies Offering EtG Testing " . No other

> permissions are granted or implied.

>

> Your signature

> Your name

> Your address

> Your telephone number

> Your email

>