This agreement contains the 'full and complete understanding between the parties and
supersedes all prior agreements and understandings pertaining hereto and cannot be
modified except by writing signed by each party.
I hereby certify and represent that I am...
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This agreement contains the 'full and complete understanding between the parties and
supersedes all prior agreements and understandings pertaining hereto and cannot be
modified except by writing signed by each party.
I hereby certify and represent that I am of legal age and have every right to contract in
my own name in connection with this Release, and that I have read the foregoing and
fully understand the meaning and effect thereof, and intending to be legally bound I
have signed this Authorization this at>1f;'" day of .Dece.Mbor ,20_l3_.
10 IQ~ tss.
Date of Birth
Ja.rd.eep kq11r JahbaL
rint Name
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Adores
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Phone
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Date
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