Experimental Consent Form

1.                I have freely volunteered to participate in this experiment.

2.                I have been informed in advance as to what my task(s) would be and what procedures would be followed.

3.                I have been given the opportunity to ask questions, and have had my questions answered to my satisfaction.

4.                I am aware that I have the right to withdraw consent and discontinue participation at any time without prejudice.

5.                My signature below may be taken as affirmation of all of the above, prior to participation.

        PRINTED NAME                            SIGNATURE

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