Form omb no. 1545-0047 990 return of organization exempt from income tax 2007 under section 501(c), 527, or 4947(a)(1) of the internal revenue code (except black lung benefit trust or private foundation) depertmart of the treasury 0, the...
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Name phone mobile home email safety considerations for exercise participation these classes involve activities and positions that may be contraindicated for participants with injuries or medical conditions. as a general rule of thumb, if an...
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2015 mother/daughter programs sunday, march 22 sunday, march 29 for 10* 12 year old girls 2:00 5:00 p.m. for 13 16 year old girls 2:00 5:30 p.m. (this program will fill up very quickly. please register early.) saint francis hospital auditorium...
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Patient label patient photo patient information: name: date of birth: ssn: address: city: zip: primary phone: work phone: cell phone: e-mail: employer: occupation: marital status: married single pharmacy name / address: do you live with your...
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Physical examination name age date height weight bp / pulse vision r20/ l20/ corrected: n y normal abnormal findings initials heent pupils equal heart pulses lungs abdominal testicles/hernia musculoskeletal (symmetry/rom/strength/flexibility) neck...
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74a100 (12-09) for official use only insurance premiums tax return commonwealth of kentucky department of revenue 3 2 2 0 0 9 / / * tax year tr. for calendar year 2009 return due march 1, 2010 account number naic/ tax id fein company name home...
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The healing center, llc dr. david greenfield 17 south highland street west hartford, ct 06119 8605618727 fax: 8605618727 .virtualaddiction.com .drdavidgreenfield.com child and adolescent developmental history please fill out this information form...
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Research41 development 6 engineering center cdcc0 acute environmental toxicity and persistence of a chemical agent simulant: ethyl sulfide (cees) .2chioroethyl a) u ') (v) o c '%j i * dominic a. cataldo, ph.d. michael w. ligotke, m.s. bruce d....
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Konkan railway corporation limited (a govt. of india undertaking) tender documents name of work : laying and linking of track for additional loop lines (loopii & ) at karmali station yard. tender notice no. : kr/kw/ol/w/2011/17(rt1) dtd.13.08.2012...
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T. 990 return of organization exempt from lncome tax 2012 under section 501(c),527, or 4947(a)(1) of the lnternal revenue code (except bldik lung benefit trust or private foundation) depart.renl of the treasury ' lnler nal revenue servtce a...
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Big bash june 1-3, 2012 make plans now to attend ok, guys enough of this procrastination! register go online at .wabash.edu and register for the big bash. after going to the website, click alumni; click big bash; click registration be sure to pay...
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Personal history questionnaire name: age: todays date: to help your therapist understand you to assist you please fill out the following sections carefully and fully. if the client is a child, please answer on their behalf. 1. in your own words,...
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Medical history confidential to be completed by the student. name: male last first middle female family history (has a blood related parent, grandparent or sibling ever had any of the following? if yes, indicate relationship) condition...
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Council meeting november 1819, 2011 sheraton toronto airport 801 dixon road, toronto, on ontario association of certified engineering technicians and technologists presidents report november 18, 2011 report to council members of technology...
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73 east valley brook road long valley, new jersey 07853 phone: (908) 876-3429 office use only office use only camper medical history form g: (to be completed by camper s parent/guardian and returned to meadowbrook within 30 days of enrollment. no...
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