Declaration of Representative. All representatives must complete this section. I declare that I am not currently under suspension or disbarment from practice within the Commonwealth or in any jurisdiction, that I am aware of regula- tions governing the practice of attorneys, certified public accountants, public accountants, enrolled agents and others, and that I am one of the following:
Appears in 7 contracts
Samples: Consumer Directed Care Agreement, Consumer Directed Care Agreement, tempusunlimited.org
