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Acknowledgement of Receipt of Member Handbook by ekh17189

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									                      Consumer Advisory Committee Program

                     Receipt of Member Handbook Form


By checking the boxes and signing below I acknowledge that I have received:


A copy of the Consumer Advisory Committee Member Handbook
DVDs containing video taken at the 2007 CAC Member Training Conference

Member’s (Printed) Name: _____________________________________

Member’s Signature: ____________________________________          Date: ____________

								
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