I agree that the Latin American Network of Assisted Reproduction uses the following material on its site http://www.redlara.com , on the Continuing Education Programme – PEC Online.

( ) Power point: _____________________________________________

( ) Movie : _________________________________________________

( ) Paper : __________________________________________________

( ) Book : ___________________________________________________

( ) Other : __________________________________________________

I shall inform that I have the authorization of the other authors (if there is any) to allow the proper inclusion on the site.

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Name Date