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On and on a separate sheet include the supplementary information requested below. Organization Information Page 1 of 2 Organization s name Organization s address (street address, city, state/province, country, ZIP/Postal code) Executive Director/President/Chairperson (name and position) Telephone number Email address Web URL Description of the organization s mission and status (e.g., public organization, charity, foundation, etc.) Brief description of research profile (e.g., disease-s.
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