rapy • Clinical stage: H1 2018 (1" trial, various cancers) EFTA00292524 Substantial Global Markets Gene Therapy Market • Genetic diseases (e.g. Sickle Cell Anemia, Primary Immuno-Deficiency, etc.) are responsible for a heavy loss of life."' • > 6,000 known single-gene defect disorders2 • "worth USD

ALTH HISTORY (Serious Illnesses Inures explain) (attach narrative it additonal space needed) C. I ARARATARY Ina inelinlaelli e Tuberculin test Sickle Cell type date result NAME: TITLE: ADDRESS: (Please Print) r-rdl- OH 3040. 10116 (lieplooli 14R5-14 Form 3040 which easy be used) Mock Plumbot. 5

ir (attach narratrve if additional space needed) C. LABORATORY (a, indicate) Hempeiptyin/Hernatocrir Stool (O & P) Tuberculin test Leao Sickle Cell type date results NAME: FAMit y talee rtrn -ra TITLE: TV) P . CENTER Ntint atii J. ADDRESS: Royal Palm Beach, F/ 57) 7 95. 4773 (P

n) (attach narrative d additional space needed) C. LABORATORY (as indicated) t- rnoglcbin/Hemafocrit Stool (O & Tuberculin test: LP 1C1 Sickle Cell d NAME: TITLE: ADDRESS: (Please Print) 1 7A /7 5 OH 3040. 10/16 (Rapacas HRS-ef Form 3040 when may 0* oseie) (Stock Nwnbsr 57444430 JU0 2)

Illnesses Injuries: explain) (attach narrative it additional space needed) C. LABORATORY Hemoglobin/Hematocrit Stool 1O & P) Tuberculin test: Sickle Cell Lead Authorized Signature OH 3040. 10190 (Replaces NRS-li Form 3040 which may be used) (Slack Number 5741-000-3040-2) EFTA01710221 ERs Studen