Acceptance of Participants. The undersigned agrees to remedy the cause of the non-compliance set out in section 1 of this form by the date specified in section 2 of this form. The undersigned acknowledges that failure to remedy the cause of non-compliance may result in any of the actions identified in section two of this form. 4 a. Participant Signature: 4 b. Participant Signature: 4 a. Date: 4 b. Date: 4 c. Participant Signature: 4 d. Participant Signature: 4 x. Xxxx: 4 d. Date:
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