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Yes, I agree to have my personal information, including personal health information, used to communicate with me or as otherwise set forth in our Privacy Notice.

Yes, additionally, I agree that Reata may share my personal information, including personal health information, with third-parties in the context of compassionate use requests or as otherwise set forth in our Privacy Notice.

Yes, additionally, I agree that Reata may use my personal information to keep me informed about Reata’s trials or other activities or information that I have requested.

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Proposed itemized budget for the program/event; Draft agenda, objectives or other supporting program/event material; Completed W-9 Form(Tax ID); Automated Clearance House(ACH) instructions, including bank name, account number, and routing number; For Accredited CME: Accreditation statement; For Charitable Donations: 501(c)(4) Tax Exempt Statement

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