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Project Name:
Date(s):
Item #
Participant Name
Amount of
Payment
Signature
(Participant or Faciliator/Interviewer)
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Principal Investigator
Printed/Typed Name:
Signature:
Date:
Tel 678-839-4759 Fax 678-839-5276
The University System of Georgia
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Affirmative Action/Equal Opportunity Institution
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Research and Sponsored Projects
Carrollton, Georgia 30118-4510!
February 2016 (v.2)