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APPOINTMENT DATE Imaging Services Locations Cayuga Medical Center 101 Dates Drive Ithaca New York 14850 Ithaca Convenient Care 10 Arrowwood Drive Ithaca New York 14850 Cortland Con. 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 No SI No SI No 1 ADILABAD 1 NELLORE 1 WEST GODAVARI 2 ANANTAPUR 2 EAST GODAVARI 2 KRISHNA 3 CHITTOOR 3 SRIKAKULAM 3 VISAKHAPAATNAM 4 CUDDAPAH 4 KURNOOL 5 KARIMNAGAR 5 PRAKASAM 6 KHAMMAM 6 GUNTUR 7 MAHBUBNAGAR 8 MEDAK 9 NALGONDA 10 NIZAMABAD 11 RANGAR REPAIR FORM Company Name If Applicable First Name Last Name Address street address preferred City City State Zip Code Country Telephone Email Address Items being repaired Item Item Descripti 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 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 tudent Entry Form ____________________________________________________________________________________________________________ STUDENT NAME: __________________________________________ ______ ______ G Stat 5411 Fall 2012 Exam 2 For some questions you may leave answers as unsimplified numerical expressions . The expressions could include mathematical notation such as య , Log 10 (45) , 10 HECKLISTREASExecutiveOfficer,IpswichCityCouncil UseOnly No:______________ Rcd:____/____/____Officer:__________________________________________ madeapplicationthedevelopmentapplicationreducesinstancesw count*&#x-0.4;䦅　):- . idbPredicate(@A,Pid,Name), . adornment(@A,Pid,Rid,Pos,Name,Sig).mg2magicPred(@A,Pid,Name,Sig):- . goalCount(@A,Pid,Name,Count), . adornment(@A,Pid, , ,Name,Sig). . BUILDING DIVISION CONTRACTOR LICENSING DEPARTMENT 772-226-1230 FAX #: 772-770-5333 INDIAN RIVER COUNTY/ CITY OF VERO BEACH COMPETENCY CARD PROCEDURES STATE CERTIFIED APPLICANTS: Complete Apprentice A Research student Affiliation mentioned on Manuscritp: __________________________