the same document. An electronic (e.g. Portable Document Format or PDF) copy of the original signature of the representative of a party shall have the same validity as an original signature for the purpose of this Agreement. 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 _____________________________________ __________________ Megan Ryan, MBA Date Technology Development Coordinator Division of Medications Development _____________________________________ Raye Z. Litten, Ph.D. Acting Director, Division of Medications Development NIAAA Mailing Address for Notices: NIAAA Megan Ryan 5635 Fishers Lane, 2051 Bethesda, MD 20892 (301) 443-4225 FOR RECIPIENT: ____________________________________ __________________ (Signature of Authorized Representative) Date Name 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
the same document. An electronic (e.g. Portable Document Format or PDF) copy of the original signature of the representative of a party shall have the same validity as an original signature for the purpose of this Agreement. 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 _____________________________________ __________________ Megan Ryan, MBA Date Technology Development Coordinator Division of Medications Development _____________________________________ Raye Z. Litten, Ph.D. Acting Director, Division of Medications Development NIAAA Mailing Address for Notices: NIAAA Megan Ryan 5635 Fishers Lane, 2051 Bethesda, MD 20892 (301) 443-4225 FOR RECIPIENT: ____________________________________ __________________ (Signature of Authorized Representative) Date Name 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
VareniclineDataTransferAgreement.docx