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Fredrica and I started with Younique Nov 2012 when Younique launched Im a founding US presenter and a Purple Exclusive leader Like most people I came across this opportunity while browsing . Partner Parents Other children Doula Other present before ANDOR during labor During labor Id like Music played I will provide The lights dimmed The room as quiet as possible As few interruptions as possible As few vaginal exams as possible Hospital Note please only include accessories related to the problem you are having Please list all included accessories Accessories Included Yes 1 2 3 Please describe the problem you are having 57417574545745957460574585746157443574605744957455574545745957 Network ID tudent Loca l Address Street AptBox City State MI End Sponsor will pay for the following check all that apply Full Tuition Health Services Partial Tuition indicate percentage or amount Medical Insurance Mandatory Fees Yes if yes state amo Policy Please List any medications medical problems or disabil ties that pertain to your Child Is your child allergic to anything Past surgery Any d etary restrictions AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT IF MY CHILD SHOULD B ID Type 2 ID Type If your position is a paid or vol unteer position and you will be in contact with children elderly andor person with disabilities please read and complete the following consent Ex teacher coach foster parent nurse care giver Do you own rent your house rent an apartment Applicants Home Environment Information Do you presently have a dog or have you owned a dog before Name Breed MF Age Are there cats in your home no yes how many Are all of your pets spayedneutered If not No Bank Name RO Name Head Office Address Pincode Ahmedabad Mercantile CoOp Bank Ltd AHMEDABAD AMCO HouseNear Stadium Circle NavrangpuraAhmedabadGujarat 380009 Kalupur Commercial CoopBank Ltd AHMEDABAD Kalupu Printed Name of Enrollment Officer Signature of Enrollment Officer brPage 2br S citizen Yes No If you answered Yes to the question above please respond to the following two questions If your answer was No skip to the following section Are you HispanicLatino Yes No Indicate your race by choosing American Indian or Alaska Native Last name First name Middle initial Curre nt Address Permanent Address if different from the current address Message Phone Alternate Phone mail Social Security Number New Application Reapplication For training to begin Fall Semester indic ate year A No NAME OF CAPF NAME OF DWO OFFICE ADDRESS STATE DISTTPLACE CONTACT NO EMAIL ADDRESS AR Col RSYadav Garrison Commander AR Training Centre Diphu PODiphu DisttKarbi Anglong Assam Assam Haflong Karbi Anglong 150 PLUS TAXES MINIMUM SUBSCRIPTION PERIOD IS FOR THREE 3 MONTHS brPage 2br GENRE CHANNEL NAME GENRE CHANNEL NAME GENRE CHANNEL NAME 573485822657348582265736257348Zd57372573475736257348EE5737257347Z57348d573725734758238E573476122057347W57372Z57347D HPCs - LACs S11 KERALA 01 KASARAGOD HPC LACs from Kannur) 02 KANNUR HPC (7 LACs from Kannur Distri Last Name First Name Team Name Coach Name Coach Phone Anderson B 1003 8016749877 Bejarano M 1005 Lorenzo-Denise Bejarano 8017063601 Brinkerhoff P 1001 Chris McCann 8018348250 Brown T 1002 Ron Childers