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 Print for Fax and Postal Mail 
 
 2) Fill in the information 3) Fax or mail it to: 
 
 Department of Neurobiology and Anatomy University of Utah School of Medicine Salt Lake City, Utah 84132 Phone: (801) 585-1281 FAX: (801) 581-3632 Email suzanne.stensaas@hsc.utah.edu If you are faxing the document, please also email suzanne.stensaas@hsc.utah.edu for pickup. 
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