Program: zumba (regular) dates: tuesdays may 31, june 7, 14, 21, 28, july 5, 2011 (6 sessions) time: 7:15 8:00 pm location: port jefferson village center instructor: denise faicco fee: $42/ residents $48/nonresidents (please make checks to inc....
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Player registration form american youth soccer organization .ayso.org region number division last name ayso id#: please fill in all of the requested information and sign where indicated. press hard. you are making four copies check if a vip player...
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Friday fax the week of (date) coventrycares of kentucky medicaid reconsideration form when filing reconsideration on a claim denial for your coventrycares of kentucky medicaid claims, please use the attached form. for coventrycares of kentucky...
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Buyer lead sheet date: lead source/property that prompted call: contact info name email street address childrens names home phone cell phone work phone fax what is the best way to get in touch with you? what times are best? buyer consultation...
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Personal credential verification permission and indemnity declaration (a) company details ( the company ) to be completed by company agent please print company name: email: branch name: phone: agent name: fax: (b) checks required criminal check:...
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Submit by email print form eastern nazarene college report of unsafe condition or hazard 1. unsafe condition or hazard date: time: please use this form for reporting unsafe conditions or hazards that need immediate attention. name (optional):...
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Purchase college department of athletics accident report form injured person s full name*: date/time of injury: status of injured person (circle): student faculty/staff visitor security officer other: local address: phone: home address: phone: *if...
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Software and library update procedures for: vs862 system software update (serial (com) port version) preparation 1. you need the following tools to update vs862 software: vs862 scanner, computer with serial port, serial cable, power adaptor cable...
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Submit this form via fax to the breathitt bd. office (606) -2493, or email darrell.watts breathitt.kyschools.us; phillip.watts breathitt.kyschools.us also send to arch.turner breathitt.kyschools.us david.napier breathitt.kyschools.us burley.hudson...
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Assessment november/december 2015 ll name: date: the monster in the cave quiz directions: read the play the monster in the cave in the november/december 2015 issue of storyworks. then fill in the bubble next to the best answer for each question...
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University of mauritius r duit, mauritius telephone: (230) 403 7632 fax: (230) 465 6977 website: http://.uom.ac.mu established 1965 application for admission - 2015 application no. (short course: sustainable aquaculture) batch 2: (29th aug to 12th...
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Employee wellness program division of kinesiology and health science (657) 278-4404 / fax (657) 278-5317 informed consent form pilates mat class name department / unit campus address e-mail address phone / fax 1. purpose and explanation of the...
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