t Sinai. We hope you will take a moment to read this authorization and sign below. If you have any questions, please call the Compliance Officer in the Mount Sinai Development Office at (212) 659.1570. Thank you. 1 authorize that the Mount Sinai Hospital and Mount Sinai School of Medicine (" Mount Since) may disclose the name

be, a. priority at Mount Sinai. - We hope you will take a mimtent to read this authorization and sign below. If you have any questions, please call the Mount Sinai Development Office at (212) 659-8500. Thank you. I authorize any doctor employed by or on the staff of The Mcrant Sinai Hospital and Mount Sinai School of Medicine