Economic Growth

LRMP DOWNLOAD SERVICE

User Guide, Data Descriptions, Order Form and Licence Agreement

GMC LRMP Download Service User Guide (Version 1.8)

Contents

Introduction ……………………………………………………………………………………………………….. 3 Background …………………………………………………………………………………………………….. 3 Purpose of this Document …………………………………………………………………………………. 3 Contact Information ………………………………………………………………………………………….. 3 Navigating the Secure File Transfer System ………………………………………………………… 4 Logging in ………………………………………………………………………………………………………..

4 SFTS Home Page ……………………………………………………………………………………………. 5 Downloading LRMP Files from STFS …………………………………………………………………… 7 LRMP Data Files ……………………………………………………………………………………………… 8 File Formats…………………………………………………………………………………………………….. 9 Other Help and Troubleshooting ………………………………………………………………………..

10 Changing Your Password………………………………………………………………………………… 10 Forgotten Password ……………………………………………………………………………………….. 10 LRMP Data Descriptions …………………………………………………………………………………. 11 Order Form ………………………………………………………………………………………………………. 13 Agreement to provide subscription services ……………………………………………………… 15

Page 2 of 20

GMC LRMP Download Service User Guide (Version 1.8)

Introduction

Background

The List of Registered Medical Practitioners (LRMP) is accessible through the GMC’s website. Through this on-line facility, it is possible to view the registration status of doctors. The LRMP download service enables authorised external organisations to download the entire medical register in a single data file. Data files are generated on a daily basis, and organisations have the option of downloading the entire medical register, or only records that have been updated in the last 24 hours. The LRMP Download Service uses the GMC’s Secure File Transfer Service (SFTS), which ensures that data is transferred securely. The SFTS also allows users to transfer files securely to the GMC.

The Essay on World Net Web Pages Service

Announcing AT&T 7/7 Offer (sm) Search for: Help -Visitors' favorite searches -Advanced Topic Search Tip: Did you know you can search here in other languages too? Click here to see the newest pages added to our index! Get pages on: Digital Art: 3-D Gallery | Games: Chess | Catholic Prophecy: Fatima | Manga: Japanese Comics | Religion: Ash Wednesday | Poems and Poetry | 10 th Anniversary of the ...

Purpose of this Document

This User Guide provides assistance with the basic capabilities of the GMC’s Secure File Transfer service, and the process of downloading LRMP files is demonstrated step by step. In addition, the format and content of the LRMP file is described.

Contact Information

If you have any questions about our download service, please contact Andrew Ledgard, the GMC’s Information Policy Manager. Email: aledgard@gmc-uk.org

Page 3 of 20

GMC LRMP Download Service User Guide (Version 1.8)

Navigating the Secure File Transfer System

Logging in

Open the login page by entering the following address into your web browser (e.g. Internet Explorer, Firefox etc.).

https://webcache.gmc-uk.org/sfts/ The following login page should be displayed:

You should have been provided with your User Name and Password already. Enter your username and password and click on the Login button.

!

For security reasons, repeated password errors will result in your account being locked. Should this happen, you will need to contact the GMC IS Helpdesk on 0161 923 6757 to have your account unlocked.

Page 4 of 20

GMC LRMP Download Service User Guide (Version 1.8)

SFTS Home Page

Once successfully logged in, you are presented with your SFTS Home page. The page is laid out as follows: • • • Navigation links Personal home directory Downloadable Group files

Navigation links

1

There are 4 navigational links:

Home Click here at any time to return to your SFTS homepage Upload File Click here to upload files onto the SFTS system. Change Password Click here to change your SFTS password Sign Off Click here to log out of SFTS

The Term Paper on Brutus Username And Password

Brutus - Introduction & Overview Jan 28 th 2000 What does Brutus do? In simple terms, Brutus is an online or remote password cracker. More specifically it is a remote interactive authentication agent. Brutus is used to recover valid access tokens (usually a username and password) for a given target system. Examples of a supported target system might be an FTP server, a password protected web ...

Page 5 of 20

GMC LRMP Download Service User Guide (Version 1.8)

Home Directory

2

This section contains files that you have uploaded to the SFTS in order to share with the GMC, or files that the SFTS Administrator has been requested to share with your organisation. This folder has been provided to enable you to share electronic information with the GMC via a secure channel. Email is NOT a secure channel for passing sensitive information. If you need to send documents to the GMC, please ensure your contact the GMC IS Helpdesk to understand the process and enable us to know when you have uploaded a file to your Home folder for our attention. They will then be able to request access to that file internally.

!

Group Files

3

In the Group Files area you will find documents that the GMC has made available to you in accordance with the information sharing agreements that have been set up between the GMC and your organisation. The example above shows a user who has access to the “Standard LRMP” group. This group contains the downloadable LRMP files.

Page 6 of 20

GMC LRMP Download Service User Guide (Version 1.8)

Downloading LRMP Files from STFS

Downloading files from SFTS is very simple. Each file in the Home or Group folders can be downloaded by clicking on the file name. Click on a file name:

A prompt will appear asking you to download the file.

At this point you should click the Save button, and select the local folder that you wish to store the file in.

LRMP data files are transferred as compressed .zip files with the data in a .csv file within that .zip file.

Page 7 of 20

GMC LRMP Download Service User Guide (Version 1.8)

LRMP Data Files

There are 2 types of LRMP data file, “Full” and “Delta” files. File Format The LRMP files are encoded using the UTF-8 format.

Full files

The “Full” file contains every record that is displayed in LRMP. This is an extremely large file, and will take longer to download and process in an external application. With around a quarter of million records, it is too large to be opened in Microsoft Excel. Typically a full file is approximately 9MB in size.

Delta files

The “Delta” file contains all LRMP records that have been updated in the last 24 hours.

The Term Paper on Small Business Year Dates Government

Y 2 K - The Big Issue Abstract and Executive Overview What is the Y 2 K issue? This paper will describe the problems associated with Y 2 K and how Industry, Government, and Small Businesses are handling the problem. The first chapter introduces the Y 2 K issues. Chapter 2 will define how this affects the different businesses and Government agencies. Chapter 3 will develop an overall plan on how to ...

Storage

LRMP data files will be stored on the Group folder for 7 days, after this point they will be automatically removed.

File Names

LRMP Download files are named in a way that helps users identify the file they are looking for. The filenames are defined as follows:

Part 1 Part 2 Part 3 Part 4

String description

gmclrmp

full OR delta

Date

zip

.zip file extension identifying this as a compressed file. Once uncompressed, the .zip is replaced with .csv, identifying this as a commaseparated file.

Identifies the file Signifies if the The date the file was format. See below for extract is the entire created in format details of this. LRMP, or simply YYYYDDMM. gmclrmp is used for updates since the Note that files are standard file format. last update file. scheduled to be generated at 2:00 a.m. on a daily basis.

The example filename here would be: gmclrmp.full.20080704.zip

Page 8 of 20

GMC LRMP Download Service User Guide (Version 1.8)

File Formats

Standard LRMP File The standard LRMP file (gmclrmp) contains the following fields:

Column GMC Ref No Surname Given Name Gender Qualification Year of Qualification Place of Qualification PR Date FR Date Specialist Register Date GP Register Date Registration Status ARF Due Date Specialty1 Sub_Specialty1 Specialty2 Sub_Specialty2 Specialty3 Sub_Specialty3 Specialty4 Sub_Specialty4 Specialty5 Sub_Specialty5 Specialty6 Sub_Specialty6 Specialty7 Sub_Specialty7 FtP Conditions Exist FtP Undertakings Exist Other Names FtP Warnings Exist Place of Qualification Country Type VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 DATE DATE DATE DATE VARCHAR2 DATE VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 VARCHAR2 Max Size 7 50 50 1 30 4 100 8 8 8 8 100 8 100 100 100 100 100 100 100 100 100 100 100 100 100 100 1 1 150 1 100 “Y”es or “N”o “Y”es or “N”o “Y”es or “N”o ddmmyyyy format ddmmyyyy format ddmmyyyy format ddmmyyyy format ddmmyyyy format “M”an or “W”oman Comments

Page 9 of 20

GMC LRMP Download Service User Guide (Version 1.8)

Other Help and Troubleshooting

The Research paper on Logical Design Varchar Section Number

DOUBLE D ESTATE AGENCY COMPANY ASSESSMENT PART 1 1. 0 INTRODUCTION The first part of the formative assessment that deals with the case study of the Double D Estate Agency Company. The estate agency is situated in Yorkshire with their head office in Melbourne, Australia. The company handles properties that are for sale or rental. Potential customers become aware of the properties as a result of ...

Changing Your Password

Your password can be changed in a few steps. Simply click on Change Password on the main menu.

You are then asked to enter your old password, as well as your new password (twice).

Once all 3 boxes are complete, click Update.

Once your password has been successfully changed, the following text will appear at the top of your Home page.

!

The Secure File Transfer Service requires you choose a complex password that can’t be easily guessed. You password should be at least 7 characters long, and should contain a mix of upper case, lower case, and numeric characters.

Forgotten Password

If you forget your password, or get locked out of your account, please request an SFTS password reset by calling the GMC IS Helpdesk on 0161 923 6757.

Page 10 of 20

GMC LRMP Download Service User Guide (Version 1.8)

LRMP Data Descriptions Item GMC Ref No Description This is the unique seven digit reference number allocated by the GMC to each registered doctor. The surname, last name or family name in mixed case. The given / first names in mixed case. Man (M) or Woman (W) This is the name of the doctor’s Primary Medical Qualification The year when Primary Medical Qualification exams were passed. The name of the Place of Study for Primary Medical Qualification This is the date that the doctor was first granted Provisional Registration. This is the date that the doctor was first granted Full Registration. This is the date that the doctor was entered into the Specialist Register. This is the date that the doctor was entered into the GP Register. The current status of a doctor’s entry in the Register, including the doctor’s Licence status. This is the date that the doctor’s Annual Retention Fee (ARF) is due. This is the specialty identified in the specialist register. Up to 7 specialties can be provided for a given doctor. This is the sub-specialty identified in the specialist register. Up to 7 sub-specialties can be provided for a given doctor.

Surname Given name Gender Qualification

Year of Qualification

Place of Qualification

PR Date

FR Date

Specialist Register Date GP Register Date Registration Status1

ARF Due Date

The Term Paper on Product life cycle and its stages

In today’s world, where market is unpredictable, strategies play crucial role in defending a firm’s product position. “The main reason why companies must continually develop new products is because products have life cycle”, (Bittel, 1980). Just as operation managers must be prepared to develop new products, they must also be prepared to develop strategies for both new and ...

Specialty1-7

Sub-Specialty1-7

1

See the following page for the list of possible Registration Statuses.

Page 11 of 20

GMC LRMP Download Service User Guide (Version 1.8)

FtP Conditions Exist

This indicates whether the doctor has active Fitness to Practise Conditions applied to their Registration. This indicates whether the doctor has active Fitness to Practise Undertakings applied to their Registration. The doctor’s other or “middle” names in mixed case. This field will contain all of the other names that the doctor has registered with the GMC. This indicates whether the doctor has an active Fitness to Practise Warning. The name of the country where a doctor undertook their Primary Medical Qualification.

FtP Undertakings Exist

Other Names

FtP Warnings Exist Place of Qualification Country

The list of Registration Statuses is as follows: • • • • • • • • • Provisionally registered with Licence Provisionally registered without a Licence Registered with Licence Registered without a Licence Suspended Not Registered – Administrative Reason Not Registered – Deceased Not Registered – Erased after Fitness to Practise panel hearing Not Registered – Having relinquished registration

Page 12 of 20

GMC LRMP Download Service User Guide (Version 1.8)

Order Form

Number of Licences

Net

VAT

Total per Item

Total Cost of Order

Annual subscription

£600.00

£120.00

£720.00

Method of payment (please tick)

Cheque Postal Order Bank Draft BACS Eurocheque Invoice Foreign Bank Transfer

Designated User Information Company Name User’s Name Address

Invoice to (if different) Company Name F.A.O. Address

Tel Email Date of Birth*

Tel Fax Email

* Date of birth will be used by us to identify a user if they contact our helpdesk. We will provide a user name and password to a single designated user. Please provide their details above. Invoices If you would like us to send you an invoice prior to payment, please tick the box above. If you would like us to include a purchase order number on the invoice, please enter in the box overleaf:

Page 13 of 20

GMC LRMP Download Service User Guide (Version 1.8) Purchase Order Number:

Payment Details Payments from within the United Kingdom 1. All orders must be paid in full 2. Orders will not be processed until payment has been made. Payment can be made by a. Cheque b. Bank draft c. Postal Order d. Cheques and Postal Orders should be crossed and made payable to ‘General Medical Council’. e. BACS (See below for details) Banking Details for BACS Payments : National Westminster Bank PLC PO Box 4RY 250 Regent Street London W1A 4RY A/C No 00413720 Sort Code 56 00 27 Please quote MR2010 Payments from outside the United Kingdom 1. All orders must be paid in full. 2. Orders will not be processed until payment has been made. 3. All bank charges, including UK bank charges, should be covered in your payment. 4. Payments must be received in Sterling. Payment can be made by: a. Crossed sterling cheque payable in the UK b. Sterling Bank Draft drawn on a UK bank. c. Crossed British Postal Order. d. Sterling Eurocheque, with Eurocard number printed on the reverse, up to a maximum of £690.00 per Eurocheque. e. Cheques and Postal Orders should be crossed and made payable to ‘General Medical Council’. e. Foreign Bank Transfer (See below for details) Banking Details for Foreign Bank Transfers: National Westminster Bank PLC PO Box 4RY 250 Regent Street London W1A 4RY IBAN: GB87 NWBK 5600 2700 4137 20 SWIFT BIC: NWBK GB 2L Please quote MR2010 VAT If your organisation is exempt from VAT please provide the GMC with the relevant VAT exemption certificate with your order form. Please return your signed and completed order form and cheque or BACS remittance details to the Information Access Team, GMC, 3 Hardman Street, Manchester M3 3AW.

Licence Agreement Please read and sign the following Licence Agreement. A signed copy of the Licence Agreement must be returned with this order form and payment.

Page 14 of 20

GMC LRMP Download Service User Guide (Version 1.8)

The List of Registered Medical Practitioners Agreement to provide subscription services

Name Address

Please complete Please complete

Telephone Email Fax

Please complete Please complete Please complete

The List of Registered Medical Practitioners – Licence and Terms of Use 1. The following terms and conditions (‘Terms’) apply to your use of a. the List of Registered Medical Practitioners (‘LRMP’); b. the daily updates to the LRMP (‘Updates’); and c. the accompanying documentation setting out the file structure of the LRMP (‘Documentation’), provided by GMC in accordance with clause 4, which together comprise ‘the Product’. 2. If you do not agree to be bound by the Terms, you may not access or use the Product. You will be deemed to have accepted the Terms each time you access the Product. 3. References to the GMC in these Terms shall mean the General Medical Council, a registered charity in England and Wales (1089278) and Scotland (SC037750).

References to ‘you’ and ‘your’ in these Terms shall mean the user of the Product. If you have any questions or queries relating to the Product, please contact the GMC whose registered office address is 350 Euston Road, London NW1 3JN or on 020 7189 5418. The Product 4. Subject to clause 16 and receipt of payment in accordance with clause 7 within ten (10) working days of your agreement to these Terms (‘Commencement Date’), the GMC

Page 15 of 20

GMC LRMP Download Service User Guide (Version 1.8) will provide you with a user name and password to allow you to access a website in order to allow you to: a. download an electronic copy of the LRMP; b. download an electronic copy of the then-current Documentation; and c. access Updates and allow you to download an electronic copy of such Updates. Payment 5. You shall pay a fee of £600.00 (Plus VAT if applicable) to the GMC to access the Product for a period of one year from the Commencement Date. 6. You shall pay the fee to the GMC as outlined in the Order Form.

Intellectual Property 7. All Intellectual Property Rights (IPR) vested in the GMC (or any of the GMC’s third party licensors or sub-contractors) prior to the Commencement Date, including all Intellectual Property Rights in the Product (‘Existing IPR’), will continue to remain vested in the GMC or its third party licensors or sub-contractors (as applicable).

8. Ownership of all Intellectual Property Rights in changes, enhancements, improvements and/or modifications made to the Existing IPR during the Term, whether or not provided to you by way of Updates or otherwise shall, upon creation, automatically vest in the GMC. 9. You expressly acknowledge that, except for the grant of the licence in accordance with clause 11, you shall not acquire any right to use the Intellectual Property Rights in the Product. 10. References to “Intellectual Property Rights” shall mean all patents, inventions, know-how, trade secrets and other confidential information, registered designs, copyrights, database rights and design rights, trade marks, service marks, logos, domain names, business names, trade names, moral rights, and all registrations or applications to register any of the aforesaid items, rights in the nature of any of the aforesaid items in any country or jurisdiction, rights in the nature of unfair competition rights and rights to sue for passing-off. Licence 11. Subject to your continuing compliance with these Terms, the GMC grants you a non-transferable, non-assignable, non-exclusive licence to possess, install, store and use the Product for the duration of the Term for the purposes of validating the registration status of medical practitioners and undertaking non-commercial research. Such licence shall not include the right to grant sublicenses. Any further use is prohibited. You shall not make, or permit any third party to make any copies of the Product in whole or in part, whether in eye-readable or machine-readable form, other than to produce hard copy print-

Page 16 of 20

GMC LRMP Download Service User Guide (Version 1.8) outs from the Product for your own private research purposes only. Save as expressly authorised by these Terms, you undertake not to use the data supplied in the Product or any part of the Product: a. to merge, alter, adapt, rearrange, extract, utilise or create derivative works from all or any part of the LRMP, the Updates or the Documentation such that the data ceases to be readily identifiable as that provided by the GMC; b. for any commercial purpose (including but not limited to sale, rental, or distribution); c. in any manner which may harm the interests or reputation of the GMC. 12. You are only permitted to use the LRMP to validate the registration status of medical practitioners and to undertake non-commercial research. 13. You acknowledge that the LRMP and the Updates contain Personal Data (as defined in the Data Protection Act 1998 (“the Act”)) and you undertake and agree that you will deal with such Personal Data strictly in accordance with these Terms and the Act. Confidentiality 14. All confidential information given by the GMC to you, which shall include the Product and all information which is disclosed after the Commencement Date by the GMC to you which would appear to a reasonable person to be confidential or is marked confidential or is accompanied by a written statement saying that it is confidential or proprietary and which relates to the business, developments, trade secrets, know-how, personnel and suppliers of the GMC, and all information derived from the above, shall be kept secret and confidential by you throughout the Term and shall not be used or disclosed other than for the purposes of the proper performance of these Terms or with the prior written consent of the GMC. 15. The obligations of confidentiality in clause 14 shall not extend to any information which you can show: a. is in, or has become part of, the public domain other than as a result of a breach of the obligations of confidentiality under Terms; b. was independently disclosed to you by a third party entitled to disclose the same; or c. is required to be disclosed under any applicable law, or by order of a court or governmental body or authority of competent jurisdiction. Liability of the GMC 16. You acknowledge and agree that the GMC is reliant upon information received from medical practitioners in the compilation of the LRMP and the Updates and the GMC is under no obligation to review or certify the accuracy of any such information. Any

Page 17 of 20

GMC LRMP Download Service User Guide (Version 1.8) information or data contained in the LRMP and/or the Updates may become incorrect as a result of changing details of medical practitioners. 17. The GMC shall use its reasonable endeavours to ensure that any necessary changes to the Product are made by the GMC within a reasonable time after the GMC has been notified of such changes. 18. While the GMC will use reasonable endeavours to ensure that the Product is normally available 24 hours a day, the GMC shall not be liable if for any reason the Product is unavailable at any time or for any period. Access to the Product may be suspended temporarily and without notice in the case of system failure, maintenance or repair or for reasons beyond the GMC’s control. 19. Subject always to clause 25, the GMC will not be liable in contract, tort (including negligence or breach of statutory duty) or otherwise for any losses or damages, whether direct or indirect, arising out of, or in connection with: a. the supply, non supply or delay in supplying the Product (subject to clause 20); b. any failure or malfunction of the Product resulting wholly or to any material extent from your negligence, operator error, use other than in accordance with the Documentation, or any other misuse or abuse or alteration or repair of the Product; c. the decompilation or modification of the data comprised within the LRMP and/or the Updates or its merger with any other data or maintenance, repair, adjustment, alteration or enhancement of the data by any person other than the GMC or its authorised agent; or d. the failure by you to implement recommendations previously communicated to you by the GMC in respect of, or solutions for faults in, the Product. 20. Where the Product is found to be defective, GMC shall at its option either: a. use reasonable endeavours to repair or replace the Product or that part of the Product which is found to be defective; or b. refund the amounts paid by you under clause 5. 21. The warranty given in clause 20 shall be your sole remedy with respect to defects in or failure or malfunction of the Product and in the event of any claim by you under the warranty you shall notify the GMC in writing of the alleged defect, failure or malfunction. 22. Except as expressly provided by these Terms and subject always to clause 25, the GMC expressly excludes all conditions, warranties, terms, representations and undertakings express or implied, statutory or otherwise in respect of the Product. 23. Subject always to clause 25, the GMC shall have no liability to you for loss of profits, revenue or goodwill or any type of special, indirect or consequential loss (including loss or damages suffered by you as a result of an action brought by a third party) whether

Page 18 of 20

GMC LRMP Download Service User Guide (Version 1.8) such loss is caused by the GMC’s breach of its contractual obligations or any tortuous act or omission, including negligence. 24. Subject always to clause 25, the GMC’s aggregate liability to you under these Terms shall be limited the sum of £600 (Plus VAT if applicable).

25. Nothing in these Terms shall limit or exclude the GMC’s liability to you for fraudulent misrepresentation, or for death or personal injury resulting from the GMC’s own negligence or that of its employees, agents or sub-contractors, or any other liability not capable of exclusion or limitation by reason of statute. Your liability 26. You shall be liable for and shall indemnify the GMC against any expense, liability, loss, claim or proceedings directly or indirectly arising as a result of or in connection with any breach of clause 11 and/or clause 13 of these Terms. Term 27. These Terms shall commence on the Commencement Date and shall continue until terminated in accordance with clause 29. 28. Termination or expiry of these Terms, however caused, shall be without prejudice to any obligations or rights of the GMC or you which may have accrued before termination or expiry and shall not affect any provision of these Terms which is expressly or by implication intended to come into effect on, or to continue in effect after, such termination or expiry. Termination 29. These Terms may be terminated: a. by the GMC in the event of a material breach by you of these Terms; or b. by either party on three (3) months’ written notice expiring at any time; 30. On termination, you shall delete the Product from your computer and destroy any back-up or other copies of the Product or part thereof. 31. In the event of termination arising pursuant to clause 29(b), GMC shall refund to you £50.00 (Plus VAT if applicable) for each whole month with respect to which you cease to have access to the Product as a result of such termination. General 32. No failure to exercise and no delay in exercising on the part of the GMC of any right, power or privilege arising under these Terms shall operate as a waiver thereof, nor shall any single or partial exercise of any right, power or privilege preclude any other or further exercise of any other right, power or privilege. The rights and remedies of the GMC under these Terms do not exclude any other rights or remedies provided by law.

Page 19 of 20

GMC LRMP Download Service User Guide (Version 1.8) These Terms shall be governed by English law and you and the GMC submit to the nonexclusive jurisdiction of the English courts. 33. Subject always to clause 25, these Terms set out the entire agreement and understanding between the parties in respect of its subject matter and supersedes all former warranties, statements, representations, understanding, undertakings and agreements (in each case whether written or oral) made by or between the parties relating to such subject matter. Subject always to clause 25, the parties have not relied upon, and will have no remedy in respect of, any warranty, statement, representation or understanding made by any party (whether or not that party is a party to these Terms) unless it is expressly set out in these Terms. 34. If any of these Terms is or becomes illegal, invalid or unenforceable in any respect, that shall not affect or impair the legality, validity or enforceability of any other provision of these Terms. If any illegal, invalid or unenforceable provision would be legal, valid or enforceable if some part of it were deleted, such provision shall apply with the minimum modification(s) necessary to make it legal, valid or enforceable. 35. In these Terms (unless the context otherwise requires) references to the singular shall include the plural and vice versa; the words “including”, “include”, “for example”, “in particular” and words of similar effect shall not limit the general effect of the words which precede them and the headings are for reference only and shall be ignored when construing these Terms.

Please sign below to confirm you have read and accept these Terms.

Print name ______________________ Date ______________________

Signed

________________________

Page 20 of 20