%PDF-1.6
%
1 0 obj
<<
/AcroForm 2 0 R
/Lang (en-US)
/MarkInfo <<
/Marked true
>>
/Metadata 3 0 R
/Pages 4 0 R
/StructTreeRoot 5 0 R
/Type /Catalog
>>
endobj
6 0 obj
<<
>>
endobj
2 0 obj
<<
/DA (/Helv 0 Tf 0 g )
/DR <<
/Encoding <<
/PDFDocEncoding 7 0 R
>>
/Font <<
/Helv 8 0 R
/ZaDb 9 0 R
>>
>>
/Fields [10 0 R 11 0 R 12 0 R 13 0 R 14 0 R 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R
20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R
30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R
40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 48 0 R 49 0 R
50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 59 0 R
60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R 69 0 R
70 0 R]
/SigFlags 1
>>
endobj
3 0 obj
<<
/Length 3472
/Subtype /XML
/Type /Metadata
>>
stream
2016-07-07T16:57:57-04:00
Microsoft® Office Word 2007
2020-09-01T11:43:21-04:00
2020-09-01T11:43:21-04:00
Microsoft® Office Word 2007
application/pdf
user
1
1.1
uuid:2cb206ca-09ec-4959-afea-f35d91776dbe
uuid:224bd437-e150-421c-9bbd-7dffe91497af
endstream
endobj
4 0 obj
<<
/Count 2
/Kids [71 0 R 72 0 R]
/Type /Pages
>>
endobj
5 0 obj
<<
/ClassMap 73 0 R
/K [74 0 R]
/ParentTree 75 0 R
/ParentTreeNextKey 55
/RoleMap 76 0 R
/Type /StructTreeRoot
>>
endobj
7 0 obj
<<
/Differences [24 /breve /caron /circumflex /dotaccent /hungarumlaut /ogonek /ring /tilde 39
/quotesingle 96 /grave 128 /bullet /dagger /daggerdbl /ellipsis /emdash /endash
/florin /fraction /guilsinglleft /guilsinglright /minus /perthousand /quotedblbase /quotedblleft /quotedblright /quoteleft
/quoteright /quotesinglbase /trademark /fi /fl /Lslash /OE /Scaron /Ydieresis /Zcaron
/dotlessi /lslash /oe /scaron /zcaron 160 /Euro 164 /currency 166
/brokenbar 168 /dieresis /copyright /ordfeminine 172 /logicalnot /.notdef /registered /macron
/degree /plusminus /twosuperior /threesuperior /acute /mu 183 /periodcentered /cedilla /onesuperior
/ordmasculine 188 /onequarter /onehalf /threequarters 192 /Agrave /Aacute /Acircumflex /Atilde
/Adieresis /Aring /AE /Ccedilla /Egrave /Eacute /Ecircumflex /Edieresis /Igrave /Iacute
/Icircumflex /Idieresis /Eth /Ntilde /Ograve /Oacute /Ocircumflex /Otilde /Odieresis /multiply
/Oslash /Ugrave /Uacute /Ucircumflex /Udieresis /Yacute /Thorn /germandbls /agrave /aacute
/acircumflex /atilde /adieresis /aring /ae /ccedilla /egrave /eacute /ecircumflex /edieresis
/igrave /iacute /icircumflex /idieresis /eth /ntilde /ograve /oacute /ocircumflex /otilde
/odieresis /divide /oslash /ugrave /uacute /ucircumflex /udieresis /yacute /thorn /ydieresis]
/Type /Encoding
>>
endobj
8 0 obj
<<
/BaseFont /Helvetica
/Encoding 7 0 R
/Name /Helv
/Subtype /Type1
/Type /Font
>>
endobj
9 0 obj
<<
/BaseFont /ZapfDingbats
/Name /ZaDb
/Subtype /Type1
/Type /Font
>>
endobj
10 0 obj
<<
/AP <<
/N 77 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [104.4 656.04 257.76 670.44]
/StructParent 5
/Subtype /Widget
/T (First Name)
/TU (First Name)
/Type /Annot
>>
endobj
11 0 obj
<<
/AP <<
/N 80 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [121.44 630.6 570.36 645.6]
/StructParent 6
/Subtype /Widget
/T (Street Address)
/TU (Street Address)
/Type /Annot
>>
endobj
12 0 obj
<<
/AP <<
/N 81 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [72.96 605.16 259.2 620.16]
/StructParent 7
/Subtype /Widget
/T (City)
/TU (City)
/Type /Annot
>>
endobj
13 0 obj
<<
/AP <<
/N 82 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [295.08 605.16 349.92 620.16]
/StructParent 8
/Subtype /Widget
/T (State)
/TU (State)
/Type /Annot
>>
endobj
14 0 obj
<<
/AP <<
/N 83 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [418.92 605.16 479.04 620.16]
/StructParent 9
/Subtype /Widget
/T (Zip Code)
/TU (Zip Code)
/Type /Annot
>>
endobj
15 0 obj
<<
/AP <<
/N 84 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [86.4 579.72 256.2 594.72]
/StructParent 10
/Subtype /Widget
/T (County)
/TU (County)
/Type /Annot
>>
endobj
16 0 obj
<<
/AP <<
/N 85 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [334.8 579.72 570.24 594.72]
/StructParent 11
/Subtype /Widget
/T (Email Address)
/TU (Email Address)
/Type /Annot
>>
endobj
17 0 obj
<<
/AP <<
/N 86 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [113.88 554.16 256.32 569.16]
/StructParent 12
/Subtype /Widget
/T (Home Phone)
/TU (Home Phone)
/Type /Annot
>>
endobj
18 0 obj
<<
/AP <<
/N 87 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [319.32 554.16 571.2 569.16]
/StructParent 13
/Subtype /Widget
/T (Cell Phone)
/TU (Cell Phone)
/Type /Annot
>>
endobj
19 0 obj
<<
/AP <<
/N 88 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [82.56 486.48 329.04 500.88]
/StructParent 14
/Subtype /Widget
/T (Name)
/TU (Name)
/Type /Annot
>>
endobj
20 0 obj
<<
/AP <<
/N 89 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [84.48 461.04 254.16 476.04]
/StructParent 15
/Subtype /Widget
/T (Phone)
/TU (Phone)
/Type /Annot
>>
endobj
21 0 obj
<<
/AP <<
/N 90 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [327.36 461.04 568.2 476.04]
/StructParent 16
/Subtype /Widget
/T (Relationship)
/TU (Relationship)
/Type /Annot
>>
endobj
22 0 obj
<<
/AP <<
/N 91 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [121.44 393.36 570.36 408.36]
/StructParent 17
/Subtype /Widget
/T (Street Address_2)
/TU (Street Address)
/Type /Annot
>>
endobj
23 0 obj
<<
/AP <<
/N 92 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [72.96 367.92 259.2 382.92]
/StructParent 18
/Subtype /Widget
/T (City_2)
/TU (City)
/Type /Annot
>>
endobj
24 0 obj
<<
/AP <<
/N 93 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [295.08 367.92 349.92 382.92]
/StructParent 19
/Subtype /Widget
/T (State_2)
/TU (State)
/Type /Annot
>>
endobj
25 0 obj
<<
/AP <<
/N 94 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [418.92 367.92 479.04 382.92]
/StructParent 20
/Subtype /Widget
/T (Zip Code_2)
/TU (Zip Code)
/Type /Annot
>>
endobj
26 0 obj
<<
/AP <<
/N 95 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [161.88 342.36 353.4 357.36]
/StructParent 21
/Subtype /Widget
/T (Current Degree Seeking)
/TU (Current Degree Seeking)
/Type /Annot
>>
endobj
27 0 obj
<<
/AP <<
/N 96 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [435.72 342.36 479.52 357.36]
/StructParent 22
/Subtype /Widget
/T (Current GPA)
/TU (Current GPA)
/Type /Annot
>>
endobj
28 0 obj
<<
/AP <<
/N 97 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [137.76 316.92 258.24 331.92]
/StructParent 23
/Subtype /Widget
/T (Desired Start Date)
/TU (Desired Start Date)
/Type /Annot
>>
endobj
29 0 obj
<<
/AP <<
/N 98 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [397.44 316.92 517.8 331.92]
/StructParent 24
/Subtype /Widget
/T (Desired Internship End Date)
/TU (Desired Internship End Date)
/Type /Annot
>>
endobj
30 0 obj
<<
/AP <<
/N 99 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [174.12 291.48 574.08 306.48]
/StructParent 25
/Subtype /Widget
/T (Internship Area of Interest)
/TU (Internship Area of Interest)
/Type /Annot
>>
endobj
31 0 obj
<<
/AP <<
/N 100 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [144.12 266.04 352.2 281.04]
/StructParent 26
/Subtype /Widget
/T (Program Supervisor)
/TU (Program Supervisor)
/Type /Annot
>>
endobj
32 0 obj
<<
/AP <<
/N 101 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [466.68 266.04 576.12 281.04]
/StructParent 27
/Subtype /Widget
/T (Supervisor Number)
/TU (Supervisor Number)
/Type /Annot
>>
endobj
33 0 obj
<<
/AP <<
/N 102 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [161.28 240.6 248.88 255.6]
/StructParent 28
/Subtype /Widget
/T (Hours Required Weekly)
/TU (Hours Required Weekly)
/Type /Annot
>>
endobj
34 0 obj
<<
/AP <<
/N 103 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [366.84 240.6 448.92 255.6]
/StructParent 29
/Subtype /Widget
/T (Total Hours Required)
/TU (Total Hours Required)
/Type /Annot
>>
endobj
35 0 obj
<<
/AP <<
/N 104 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [108.36 198.36 272.52 212.76]
/StructParent 30
/Subtype /Widget
/T (High School)
/TU (High School)
/Type /Annot
>>
endobj
36 0 obj
<<
/AP <<
/N 105 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [341.04 198.36 494.64 213.36]
/StructParent 31
/Subtype /Widget
/T (Degree)
/TU (Degree)
/Type /Annot
>>
endobj
37 0 obj
<<
/AP <<
/N 106 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [543.96 198.36 571.44 213.36]
/StructParent 32
/Subtype /Widget
/T (Year)
/TU (Year)
/Type /Annot
>>
endobj
38 0 obj
<<
/AP <<
/N 107 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [102.6 182.88 272.4 197.76]
/StructParent 33
/Subtype /Widget
/T (Associates)
/TU (Associates)
/Type /Annot
>>
endobj
39 0 obj
<<
/AP <<
/N 108 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [341.04 182.88 494.52 197.76]
/StructParent 34
/Subtype /Widget
/T (Degree_2)
/TU (Degree)
/Type /Annot
>>
endobj
40 0 obj
<<
/AP <<
/N 109 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [543.96 182.88 571.44 197.76]
/StructParent 35
/Subtype /Widget
/T (Year_2)
/TU (Year)
/Type /Annot
>>
endobj
41 0 obj
<<
/AP <<
/N 110 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [102.24 167.52 272.16 182.28]
/StructParent 36
/Subtype /Widget
/T (Bachelors)
/TU <42616368656C6F729073>
/Type /Annot
>>
endobj
42 0 obj
<<
/AP <<
/N 111 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [341.04 167.52 494.52 182.28]
/StructParent 37
/Subtype /Widget
/T (Degree_3)
/TU (Degree)
/Type /Annot
>>
endobj
43 0 obj
<<
/AP <<
/N 112 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [543.96 167.52 571.32 182.28]
/StructParent 38
/Subtype /Widget
/T (Year_3)
/TU (Year)
/Type /Annot
>>
endobj
44 0 obj
<<
/AP <<
/N 113 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [97.92 151.92 273.24 166.92]
/StructParent 39
/Subtype /Widget
/T (Graduate)
/TU (Graduate)
/Type /Annot
>>
endobj
45 0 obj
<<
/AP <<
/N 114 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [340.08 151.92 493.44 166.92]
/StructParent 40
/Subtype /Widget
/T (Degree_4)
/TU (Degree)
/Type /Annot
>>
endobj
46 0 obj
<<
/AP <<
/N 115 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [543.96 151.92 571.32 166.92]
/StructParent 41
/Subtype /Widget
/T (Year_4)
/TU (Year)
/Type /Annot
>>
endobj
47 0 obj
<<
/AP <<
/N 116 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 78 0 R
>>
/Font <<
/Helv 79 0 R
>>
>>
/F 4
/FT /Tx
/P 71 0 R
/Rect [200.76 84.24 573 99.24]
/StructParent 42
/Subtype /Widget
/T (If yes please specify languages)
/TU (If yes, please specify language\(s)
/Type /Annot
>>
endobj
48 0 obj
<<
/AP <<
/N 117 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 118 0 R
>>
/Font <<
/Helv 119 0 R
>>
>>
/F 4
/FT /Tx
/P 72 0 R
/Rect [284.28 703.68 574.44 727.92]
/StructParent 44
/Subtype /Widget
/T (What organizations to you belong to if applicable)
/TU (What organizations to you belong to \(if applicable)
/Type /Annot
>>
endobj
49 0 obj
<<
/AP <<
/N 120 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 118 0 R
>>
/Font <<
/Helv 119 0 R
>>
>>
/F 4
/FT /Tx
/P 72 0 R
/Rect [146.88 610.56 327.6 634.8]
/StructParent 45
/Subtype /Widget
/T (If yes which branch)
/TU (If yes, which branch)
/Type /Annot
>>
endobj
50 0 obj
<<
/AP <<
/N 121 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 118 0 R
>>
/Font <<
/Helv 119 0 R
>>
>>
/F 4
/FT /Tx
/P 72 0 R
/Rect [163.2 527.4 294.6 551.64]
/StructParent 46
/Subtype /Widget
/T (Date of your last TB test)
/TU (Date of your last TB test)
/Type /Annot
>>
endobj
51 0 obj
<<
/AP <<
/N 122 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 118 0 R
>>
/Font <<
/Helv 119 0 R
>>
>>
/F 4
/FT /Tx
/P 72 0 R
/Rect [432 527.4 563.4 551.64]
/StructParent 47
/Subtype /Widget
/T (Date of your last flu vaccine)
/TU (Date of your last flu vaccine)
/Type /Annot
>>
endobj
52 0 obj
<<
/AP <<
/N 123 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 118 0 R
>>
/Font <<
/Helv 119 0 R
>>
>>
/F 4
/FT /Tx
/P 72 0 R
/Rect [50.4 435.6 564.96 459.84]
/StructParent 48
/Subtype /Widget
/T (If yes please specify)
/TU (If yes, please specify)
/Type /Annot
>>
endobj
53 0 obj
<<
/AP <<
/N 124 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 118 0 R
>>
/Font <<
/Helv 119 0 R
>>
>>
/F 4
/FT /Tx
/P 72 0 R
/Rect [106.56 227.4 352.92 251.64]
/StructParent 50
/Subtype /Widget
/T (Print Name)
/TU (Print Name)
/Type /Annot
>>
endobj
54 0 obj
<<
/AP <<
/N 125 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 118 0 R
>>
/Font <<
/Helv 119 0 R
>>
>>
/F 4
/FT /Sig
/P 72 0 R
/Rect [98.52 201.96 355.8 226.2]
/StructParent 51
/Subtype /Widget
/T (Signature)
/TU (Signature)
/Type /Annot
>>
endobj
55 0 obj
<<
/AP <<
/N 126 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 118 0 R
>>
/Font <<
/Helv 119 0 R
>>
>>
/F 4
/FT /Tx
/P 72 0 R
/Rect [77.16 176.52 356.28 200.76]
/StructParent 52
/Subtype /Widget
/T (Date)
/TU (Date)
/Type /Annot
>>
endobj
56 0 obj
<<
/DA (/Helv 12 Tf 0 g)
/F 4
/FT /Tx
/MK <<
>>
/P 71 0 R
/Rect [439.738 670.354 571.205 687.732]
/Subtype /Widget
/T (Text1)
/Type /Annot
>>
endobj
57 0 obj
<<
/AP <<
/D <<
/Off 127 0 R
/Yes 128 0 R
>>
/N <<
/Off 129 0 R
/Yes 130 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 71 0 R
/Rect [244.802 527.553 261.425 542.664]
/Subtype /Widget
/T (Check Box2)
/Type /Annot
>>
endobj
58 0 obj
<<
/AP <<
/D <<
/Off 131 0 R
/Yes 132 0 R
>>
/N <<
/Off 133 0 R
/Yes 134 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 71 0 R
/Rect [318.092 527.553 333.959 542.664]
/Subtype /Widget
/T (Check Box3)
/Type /Annot
>>
endobj
59 0 obj
<<
/AP <<
/D <<
/Off 135 0 R
/Yes 136 0 R
>>
/N <<
/Off 137 0 R
/Yes 138 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 71 0 R
/Rect [390.626 527.553 408.004 542.664]
/Subtype /Widget
/T (Check Box4)
/Type /Annot
>>
endobj
60 0 obj
<<
/DA (/Helv 12 Tf 0 g)
/F 4
/FT /Tx
/MK <<
>>
/P 71 0 R
/Rect [80.8452 417.241 570.45 434.619]
/Subtype /Widget
/T (Text5)
/Type /Annot
>>
endobj
61 0 obj
<<
/AP <<
/D <<
/Off 139 0 R
/Yes 140 0 R
>>
/N <<
/Off 141 0 R
/Yes 142 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 71 0 R
/Rect [278.803 106.705 295.425 122.571]
/Subtype /Widget
/T (Check Box6)
/Type /Annot
>>
endobj
62 0 obj
<<
/AP <<
/D <<
/Off 143 0 R
/Yes 144 0 R
>>
/N <<
/Off 145 0 R
/Yes 146 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 71 0 R
/Rect [354.359 106.705 370.226 122.571]
/Subtype /Widget
/T (Check Box7)
/Type /Annot
>>
endobj
63 0 obj
<<
/DA (/Helv 12 Tf 0 g)
/F 4
/FT /Tx
/MK <<
>>
/P 72 0 R
/Rect [49.1116 727.022 573.472 742.888]
/Subtype /Widget
/T (Text8)
/Type /Annot
>>
endobj
64 0 obj
<<
/AP <<
/D <<
/Off 147 0 R
/Yes 148 0 R
>>
/N <<
/Off 149 0 R
/Yes 150 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 72 0 R
/Rect [281.825 659.021 299.958 675.643]
/Subtype /Widget
/T (Check Box9)
/Type /Annot
>>
endobj
65 0 obj
<<
/AP <<
/D <<
/Off 151 0 R
/Yes 152 0 R
>>
/N <<
/Off 153 0 R
/Yes 154 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 72 0 R
/Rect [353.603 658.265 370.226 676.399]
/Subtype /Widget
/T (Check Box10)
/Type /Annot
>>
endobj
66 0 obj
<<
/AP <<
/D <<
/Off 155 0 R
/Yes 156 0 R
>>
/N <<
/Off 157 0 R
/Yes 158 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 72 0 R
/Rect [247.069 634.087 262.936 649.199]
/Subtype /Widget
/T (Check Box11)
/Type /Annot
>>
endobj
67 0 obj
<<
/AP <<
/D <<
/Off 159 0 R
/Yes 160 0 R
>>
/N <<
/Off 161 0 R
/Yes 162 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 72 0 R
/Rect [354.359 634.087 370.981 649.199]
/Subtype /Widget
/T (Check Box12)
/Type /Annot
>>
endobj
68 0 obj
<<
/AP <<
/D <<
/Off 163 0 R
/Yes 164 0 R
>>
/N <<
/Off 165 0 R
/Yes 166 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 72 0 R
/Rect [461.649 634.087 480.538 649.954]
/Subtype /Widget
/T (Check Box13)
/Type /Annot
>>
endobj
69 0 obj
<<
/AP <<
/D <<
/Off 167 0 R
/Yes 168 0 R
>>
/N <<
/Off 169 0 R
/Yes 170 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 72 0 R
/Rect [66.4895 482.975 83.8675 498.842]
/Subtype /Widget
/T (Check Box14)
/Type /Annot
>>
endobj
70 0 obj
<<
/AP <<
/D <<
/Off 171 0 R
/Yes 172 0 R
>>
/N <<
/Off 173 0 R
/Yes 174 0 R
>>
>>
/AS /Off
/DA (/ZaDb 0 Tf 0 g)
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 72 0 R
/Rect [171.513 483.73 188.891 498.842]
/Subtype /Widget
/T (Check Box15)
/Type /Annot
>>
endobj
71 0 obj
<<
/Annots [10 0 R 11 0 R 12 0 R 13 0 R 14 0 R 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R
20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R
30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R
40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 56 0 R 57 0 R
58 0 R 59 0 R 60 0 R 61 0 R 62 0 R]
/Contents [175 0 R 176 0 R 177 0 R 178 0 R 179 0 R 180 0 R 181 0 R 182 0 R]
/CropBox [0 0 612 792]
/Group <<
/CS /DeviceRGB
/S /Transparency
/Type /Group
>>
/MediaBox [0 0 612 792]
/Parent 4 0 R
/Resources <<
/Font <<
/C2_0 183 0 R
/C2_1 184 0 R
/TT0 185 0 R
/TT1 186 0 R
/TT2 187 0 R
>>
/ProcSet [/PDF /Text /ImageC]
/XObject <<
/Im0 188 0 R
>>
>>
/Rotate 0
/StructParents 0
/Tabs /S
/Type /Page
>>
endobj
72 0 obj
<<
/Annots [48 0 R 49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 63 0 R 64 0 R
65 0 R 66 0 R 67 0 R 68 0 R 69 0 R 70 0 R]
/Contents 189 0 R
/CropBox [0 0 612 792]
/Group <<
/CS /DeviceRGB
/S /Transparency
/Type /Group
>>
/MediaBox [0 0 612 792]
/Parent 4 0 R
/Resources <<
/Font <<
/C2_0 190 0 R
/C2_1 184 0 R
/C2_2 191 0 R
/C2_3 192 0 R
/TT0 185 0 R
/TT1 187 0 R
/TT2 186 0 R
/TT3 193 0 R
>>
/ProcSet [/PDF /Text]
>>
/Rotate 0
/StructParents 2
/Tabs /S
/Type /Page
>>
endobj
73 0 obj
<<
>>
endobj
74 0 obj
<<
/K [194 0 R 195 0 R 196 0 R 197 0 R 198 0 R 199 0 R 200 0 R 201 0 R 202 0 R 203 0 R
204 0 R 205 0 R 206 0 R 207 0 R 208 0 R 209 0 R 210 0 R 211 0 R 212 0 R 213 0 R
214 0 R 215 0 R 216 0 R 217 0 R 218 0 R 219 0 R 220 0 R 221 0 R 222 0 R 223 0 R
224 0 R 225 0 R 226 0 R 227 0 R 228 0 R 229 0 R 230 0 R 231 0 R 232 0 R 233 0 R
234 0 R 235 0 R 236 0 R 237 0 R 238 0 R 239 0 R 240 0 R 241 0 R 242 0 R 243 0 R
244 0 R 245 0 R 246 0 R 247 0 R 248 0 R 249 0 R]
/P 5 0 R
/S /Sect
/Type /StructElem
>>
endobj
75 0 obj
<<
/Nums [0 [250 0 R 251 0 R 252 0 R 196 0 R 197 0 R 197 0 R 253 0 R 197 0 R 198 0 R 198 0 R
254 0 R 199 0 R 199 0 R 255 0 R 199 0 R 199 0 R 256 0 R 199 0 R 199 0 R 257 0 R
200 0 R 200 0 R 258 0 R 200 0 R 200 0 R 259 0 R 201 0 R 201 0 R 260 0 R 201 0 R
201 0 R 261 0 R 202 0 R 203 0 R 204 0 R 204 0 R 262 0 R 205 0 R 205 0 R 263 0 R
205 0 R 205 0 R 264 0 R 206 0 R 207 0 R 265 0 R 208 0 R 208 0 R 266 0 R 209 0 R
209 0 R 267 0 R 209 0 R 209 0 R 268 0 R 209 0 R 209 0 R 269 0 R 210 0 R 210 0 R
270 0 R 210 0 R 210 0 R 271 0 R 211 0 R 211 0 R 272 0 R 211 0 R 211 0 R 273 0 R
212 0 R 212 0 R 274 0 R 213 0 R 213 0 R 275 0 R 213 0 R 213 0 R 276 0 R 214 0 R
214 0 R 277 0 R 214 0 R 214 0 R 278 0 R 215 0 R 216 0 R 216 0 R 279 0 R 216 0 R
216 0 R 280 0 R 216 0 R 216 0 R 281 0 R 217 0 R 217 0 R 282 0 R 217 0 R 217 0 R
283 0 R 217 0 R 217 0 R 284 0 R 218 0 R 218 0 R 285 0 R 218 0 R 218 0 R 286 0 R
218 0 R 218 0 R 287 0 R 219 0 R 219 0 R 288 0 R 219 0 R 219 0 R 289 0 R 219 0 R
219 0 R 290 0 R 220 0 R 221 0 R 222 0 R 222 0 R 291 0 R 195 0 R]
2 [224 0 R 292 0 R 225 0 R 225 0 R 293 0 R 226 0 R 227 0 R 228 0 R 229 0 R 229 0 R
294 0 R 230 0 R 231 0 R 232 0 R 232 0 R 295 0 R 232 0 R 232 0 R 296 0 R 233 0 R
234 0 R 234 0 R 297 0 R 237 0 R 238 0 R 239 0 R 240 0 R 240 0 R 298 0 R 241 0 R
241 0 R 299 0 R 242 0 R 242 0 R 300 0 R 244 0 R 301 0 R 302 0 R 246 0 R 247 0 R
248 0 R 249 0 R]
4 303 0 R 5 304 0 R 6 305 0 R
7 306 0 R 8 307 0 R 9 308 0 R 10 309 0 R 11 310 0 R
12 311 0 R 13 312 0 R 14 313 0 R 15 314 0 R 16 315 0 R
17 316 0 R 18 317 0 R 19 318 0 R 20 319 0 R 21 320 0 R
22 321 0 R 23 322 0 R 24 323 0 R 25 324 0 R 26 325 0 R
27 326 0 R 28 327 0 R 29 328 0 R 30 329 0 R 31 330 0 R
32 331 0 R 33 332 0 R 34 333 0 R 35 334 0 R 36 335 0 R
37 336 0 R 38 337 0 R 39 338 0 R 40 339 0 R 41 340 0 R
42 341 0 R 43 223 0 R 44 342 0 R 45 343 0 R 46 344 0 R
47 345 0 R 48 346 0 R 49 236 0 R 50 347 0 R 51 348 0 R
52 349 0 R 53 243 0 R 54 350 0 R]
>>
endobj
76 0 obj
<<
/Annotation /Sect
/Artifact /Sect
/ArtifactSpan /Span
/Chart /Sect
/Chartsheet /Part
/Diagram /Figure
/Dialogsheet /Part
/Endnote /Note
/Footer /Sect
/Footnote /Note
/Header /Sect
/InlineShape /Sect
/Macrosheet /Part
/Slide /Part
/Textbox /Sect
/Workbook /Document
/Worksheet /Part
>>
endobj
77 0 obj
<<
/Length 12
/BBox [0 0 153.36 14.4]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
78 0 obj
<<
/Differences [24 /breve /caron /circumflex /dotaccent /hungarumlaut /ogonek /ring /tilde 39
/quotesingle 96 /grave 128 /bullet /dagger /daggerdbl /ellipsis /emdash /endash
/florin /fraction /guilsinglleft /guilsinglright /minus /perthousand /quotedblbase /quotedblleft /quotedblright /quoteleft
/quoteright /quotesinglbase /trademark /fi /fl /Lslash /OE /Scaron /Ydieresis /Zcaron
/dotlessi /lslash /oe /scaron /zcaron 160 /Euro 164 /currency 166
/brokenbar 168 /dieresis /copyright /ordfeminine 172 /logicalnot /.notdef /registered /macron
/degree /plusminus /twosuperior /threesuperior /acute /mu 183 /periodcentered /cedilla /onesuperior
/ordmasculine 188 /onequarter /onehalf /threequarters 192 /Agrave /Aacute /Acircumflex /Atilde
/Adieresis /Aring /AE /Ccedilla /Egrave /Eacute /Ecircumflex /Edieresis /Igrave /Iacute
/Icircumflex /Idieresis /Eth /Ntilde /Ograve /Oacute /Ocircumflex /Otilde /Odieresis /multiply
/Oslash /Ugrave /Uacute /Ucircumflex /Udieresis /Yacute /Thorn /germandbls /agrave /aacute
/acircumflex /atilde /adieresis /aring /ae /ccedilla /egrave /eacute /ecircumflex /edieresis
/igrave /iacute /icircumflex /idieresis /eth /ntilde /ograve /oacute /ocircumflex /otilde
/odieresis /divide /oslash /ugrave /uacute /ucircumflex /udieresis /yacute /thorn /ydieresis]
/Type /Encoding
>>
endobj
79 0 obj
<<
/BaseFont /Helvetica
/Name /Helv
/Subtype /Type1
/Type /Font
>>
endobj
80 0 obj
<<
/Length 12
/BBox [0 0 448.92 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
81 0 obj
<<
/Length 12
/BBox [0 0 186.24 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
82 0 obj
<<
/Length 12
/BBox [0 0 54.84 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
83 0 obj
<<
/Length 12
/BBox [0 0 60.12 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
84 0 obj
<<
/Length 12
/BBox [0 0 169.8 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
85 0 obj
<<
/Length 12
/BBox [0 0 235.44 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
86 0 obj
<<
/Length 12
/BBox [0 0 142.44 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
87 0 obj
<<
/Length 12
/BBox [0 0 251.88 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
88 0 obj
<<
/Length 12
/BBox [0 0 246.48 14.4]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
89 0 obj
<<
/Length 12
/BBox [0 0 169.68 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
90 0 obj
<<
/Length 12
/BBox [0 0 240.84 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
91 0 obj
<<
/Length 12
/BBox [0 0 448.92 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
92 0 obj
<<
/Length 12
/BBox [0 0 186.24 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
93 0 obj
<<
/Length 12
/BBox [0 0 54.84 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
94 0 obj
<<
/Length 12
/BBox [0 0 60.12 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
95 0 obj
<<
/Length 12
/BBox [0 0 191.52 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
96 0 obj
<<
/Length 12
/BBox [0 0 43.8 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
97 0 obj
<<
/Length 12
/BBox [0 0 120.48 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
98 0 obj
<<
/Length 12
/BBox [0 0 120.36 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
99 0 obj
<<
/Length 12
/BBox [0 0 399.96 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
100 0 obj
<<
/Length 12
/BBox [0 0 208.08 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
101 0 obj
<<
/Length 12
/BBox [0 0 109.44 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
102 0 obj
<<
/Length 12
/BBox [0 0 87.6 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
103 0 obj
<<
/Length 12
/BBox [0 0 82.08 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
104 0 obj
<<
/Length 12
/BBox [0 0 164.16 14.4]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
105 0 obj
<<
/Length 12
/BBox [0 0 153.6 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
106 0 obj
<<
/Length 12
/BBox [0 0 27.48 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
107 0 obj
<<
/Length 12
/BBox [0 0 169.8 14.88]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
108 0 obj
<<
/Length 12
/BBox [0 0 153.48 14.88]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
109 0 obj
<<
/Length 12
/BBox [0 0 27.48 14.88]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
110 0 obj
<<
/Length 12
/BBox [0 0 169.92 14.76]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
111 0 obj
<<
/Length 12
/BBox [0 0 153.48 14.76]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
112 0 obj
<<
/Length 12
/BBox [0 0 27.36 14.76]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
113 0 obj
<<
/Length 12
/BBox [0 0 175.32 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
114 0 obj
<<
/Length 12
/BBox [0 0 153.36 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
115 0 obj
<<
/Length 12
/BBox [0 0 27.36 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
116 0 obj
<<
/Length 12
/BBox [0 0 372.24 15]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
117 0 obj
<<
/Length 12
/BBox [0 0 290.16 24.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
118 0 obj
<<
/Differences [24 /breve /caron /circumflex /dotaccent /hungarumlaut /ogonek /ring /tilde 39
/quotesingle 96 /grave 128 /bullet /dagger /daggerdbl /ellipsis /emdash /endash
/florin /fraction /guilsinglleft /guilsinglright /minus /perthousand /quotedblbase /quotedblleft /quotedblright /quoteleft
/quoteright /quotesinglbase /trademark /fi /fl /Lslash /OE /Scaron /Ydieresis /Zcaron
/dotlessi /lslash /oe /scaron /zcaron 160 /Euro 164 /currency 166
/brokenbar 168 /dieresis /copyright /ordfeminine 172 /logicalnot /.notdef /registered /macron
/degree /plusminus /twosuperior /threesuperior /acute /mu 183 /periodcentered /cedilla /onesuperior
/ordmasculine 188 /onequarter /onehalf /threequarters 192 /Agrave /Aacute /Acircumflex /Atilde
/Adieresis /Aring /AE /Ccedilla /Egrave /Eacute /Ecircumflex /Edieresis /Igrave /Iacute
/Icircumflex /Idieresis /Eth /Ntilde /Ograve /Oacute /Ocircumflex /Otilde /Odieresis /multiply
/Oslash /Ugrave /Uacute /Ucircumflex /Udieresis /Yacute /Thorn /germandbls /agrave /aacute
/acircumflex /atilde /adieresis /aring /ae /ccedilla /egrave /eacute /ecircumflex /edieresis
/igrave /iacute /icircumflex /idieresis /eth /ntilde /ograve /oacute /ocircumflex /otilde
/odieresis /divide /oslash /ugrave /uacute /ucircumflex /udieresis /yacute /thorn /ydieresis]
/Type /Encoding
>>
endobj
119 0 obj
<<
/BaseFont /Helvetica
/Name /Helv
/Subtype /Type1
/Type /Font
>>
endobj
120 0 obj
<<
/Length 12
/BBox [0 0 180.72 24.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
121 0 obj
<<
/Length 12
/BBox [0 0 131.4 24.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
122 0 obj
<<
/Length 12
/BBox [0 0 131.4 24.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
123 0 obj
<<
/Length 12
/BBox [0 0 514.56 24.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
124 0 obj
<<
/Length 12
/BBox [0 0 246.36 24.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
125 0 obj
<<
/Length 12
/BBox [0 0 257.28 24.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
126 0 obj
<<
/Length 12
/BBox [0 0 279.12 24.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
127 0 obj
<<
/Length 59
/BBox [0.0 0.0 16.6224 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P043322Q043444V(JJ23U a D.Y`
endstream
endobj
128 0 obj
<<
/Length 125
/BBox [0.0 0.0 16.6224 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
1~bJml6#hg#,vށ?i&'$&jsĈ$y=.XVi![w쮷Ý97bҤgR8aS3
endstream
endobj
129 0 obj
<<
/Length 53
/BBox [0.0 0.0 16.6224 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P043322Q043444V(JJ23U a D.Y` Hp
endstream
endobj
130 0 obj
<<
/Length 121
/BBox [0.0 0.0 16.6224 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
@~bJm֛ۓA;aAS4A}0!bG$&Y˹Rn
OH7?| jN.xO#z;)1e/kdk8aS3
endstream
endobj
131 0 obj
<<
/Length 57
/BBox [0.0 0.0 15.8668 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P04ճ03 ц
E\i\z
lh4Ks
endstream
endobj
132 0 obj
<<
/Length 129
/BBox [0.0 0.0 15.8668 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<α
@r9{En ^K)!=UBBܕMSUOvZy>PjeJzʞR`,nD@3)N-- 1!W
endstream
endobj
133 0 obj
<<
/Length 51
/BBox [0.0 0.0 15.8668 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P04ճ03 ц
E\i\z
lh4Ks K8
endstream
endobj
134 0 obj
<<
/Length 125
/BBox [0.0 0.0 15.8668 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<1@7r^.n.B@pSRJ#b+SD=b0+yż#mt%optӓ"RUb/4.pv\`
endstream
endobj
135 0 obj
<<
/Length 58
/BBox [0.0 0.0 17.378 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P0436P043444V(JJ23U aC3 \ {Q
endstream
endobj
136 0 obj
<<
/Length 129
/BBox [0.0 0.0 17.378 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<ν
1~bJmlO+N;8P̝p6
:kGGrjNi[\7: \0vSU6 HX$yГMܲpl8' ?)
endstream
endobj
137 0 obj
<<
/Length 52
/BBox [0.0 0.0 17.378 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P0436P043444V(JJ23U aC3 \ 3
endstream
endobj
138 0 obj
<<
/Length 126
/BBox [0.0 0.0 17.378 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<α
@~bJmۻ˥lN,)7RMT5Ā -J다U.ވcwTHR5W&)f@Z[G? ~|
endstream
endobj
139 0 obj
<<
/Length 59
/BBox [0.0 0.0 16.6224 15.8668]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P043322Q04ճ03P(JJ23U a D.Y`
endstream
endobj
140 0 obj
<<
/Length 128
/BBox [0.0 0.0 16.6224 15.8668]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<=ACڌ;_c+w`!4A 56rD`)fKq~$sJL
NhVqQgz]rߨ&ַDQugZ=ݡ*nv`lON 0 !@
endstream
endobj
141 0 obj
<<
/Length 53
/BBox [0.0 0.0 16.6224 15.8668]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P043322Q04ճ03P(JJ23U a D.Y` L
endstream
endobj
142 0 obj
<<
/Length 124
/BBox [0.0 0.0 16.6224 15.8668]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<λ
Q~bJmɹl`.Xua4C#J1SXy/&(uN.x{z;ܩQb+> fXTEpt` ̧
endstream
endobj
143 0 obj
<<
/Length 52
/BBox [0.0 0.0 15.8668 15.8668]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P04ճ03E\i\z
lh4Ks
endstream
endobj
144 0 obj
<<
/Length 126
/BBox [0.0 0.0 15.8668 15.8668]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<
1D)Y[FX(Gy0;AJm@R~`D̟5-0uʦssl.jb}IIRJ;Tҏ-X5ㄯ J!a
endstream
endobj
145 0 obj
<<
/Length 46
/BBox [0.0 0.0 15.8668 15.8668]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P04ճ03E\i\z
lh4Ks O2
endstream
endobj
146 0 obj
<<
/Length 121
/BBox [0.0 0.0 15.8668 15.8668]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<11<^kgEx )zq D9!0Pa=?Ol+]nvSMd0)IQJTSiyъM_8: 0 \ *
endstream
endobj
147 0 obj
<<
/Length 59
/BBox [0.0 0.0 18.1335 16.6224]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P03466U043322Q(JJ23U aCs)\ f
endstream
endobj
148 0 obj
<<
/Length 126
/BBox [0.0 0.0 18.1335 16.6224]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̽
A>ORqgggZFXA}@ R<6@fN͒cL|1 s?y rĶcsTм0X&TcAdթJkG| S
endstream
endobj
149 0 obj
<<
/Length 53
/BBox [0.0 0.0 18.1335 16.6224]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P03466U043322Q(JJ23U aCs)\ I
endstream
endobj
150 0 obj
<<
/Length 122
/BBox [0.0 0.0 18.1335 16.6224]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
0F]~s4]E7! )ڂ?آt88G3UĘc@9QGim|])m[ӭvnP"MUZ=o8+
endstream
endobj
151 0 obj
<<
/Length 59
/BBox [0.0 0.0 16.6224 18.1335]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P043322Q03466U(JJ23U aCS9\ f
endstream
endobj
152 0 obj
<<
/Length 124
/BBox [0.0 0.0 16.6224 18.1335]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
@~bJm۽يv6`hgax')5HJzP lv?>JA%VRO45qr\`
endstream
endobj
153 0 obj
<<
/Length 53
/BBox [0.0 0.0 16.6224 18.1335]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P043322Q03466U(JJ23U aCS9\ I
endstream
endobj
154 0 obj
<<
/Length 119
/BBox [0.0 0.0 16.6224 18.1335]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̽
A>ORu?ևv6`XR|a `)\cDθ]~e&[g9aplΗ#RPK~C7%*k{_ u
endstream
endobj
155 0 obj
<<
/Length 57
/BBox [0.0 0.0 15.8668 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P04ճ03 ц
E\i\z
lh4Ks
endstream
endobj
156 0 obj
<<
/Length 125
/BBox [0.0 0.0 15.8668 15.1113]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<1@vrVm
>x>xFԹ/_ZU/vZyż(l+69T)F=Q