Request for Access of Information

"I		Please select... Physician Pharmacist Nurse or Other Health Care Provider	from
	(Name)	(Designation)		(Country)

request access to the Safety and Efficacy Data presented on the WinRho for ITP website. I would like to use this information for educational purposes. Please provide me with a password in order to access this information."

My tick in the box indicates my signature for this request.

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