If you have an interest in partnership or collaboration with Ferndale Healthcare^®, we invite you to complete the Ferndale Healthcare^® Corporate Opportunity Submission Form.

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Name

Title

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Address

Apt., Suite, Bldg. (optional)

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Nonconfidential description of product or area of interest

Nonconfidential & Owner

Yes, I hereby certify that the above information is nonconfidential and I have ownership of any technology or am empowered by the owner of any technology to offer the technology to Ferndale Pharma Group, Inc. for consideration.

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