ࡱ> !# y 4bjbjEE 4$''")U!!!!"#| $@'''''''$*g-d'J$""J$J$'!!('''J$ !!''J$''''!Kѽ=T$^''(0)'-$V-'',-J'pJ$J$'J$J$J$J$J$'''J$J$J$)J$J$J$J$-J$J$J$J$J$J$J$J$J$ :  Diver s Annual Medical Form 2007-2008  All information will be kept CONFIDENTIAL within the Medical Team Section 1: Contact Details of Diver Surname: FORMTEXT      First and middle names: FORMTEXT      Female/Male (please check):Male  FORMCHECKBOX  / Female  FORMCHECKBOX Date of Birth: FORMTEXT      Address:Address:Tel:Home:  FORMTEXT       Work:  FORMTEXT       Cell:  FORMTEXT      Email: FORMTEXT       Parent / Guardian / Next of KinRelationship to Diver: FORMTEXT      Surname: FORMTEXT      First and middle names: FORMTEXT      Female/Male (please check):Male  FORMCHECKBOX  / Female  FORMCHECKBOX Date of Birth: FORMTEXT      Address:Address:Tel:Home:  FORMTEXT       Work:  FORMTEXT       Cell:  FORMTEXT      Email: FORMTEXT       Parent / Guardian / Next of KinRelationship to Diver: FORMTEXT      Surname: FORMTEXT      First and middle names: FORMTEXT      Female/Male (please check):Male  FORMCHECKBOX  / Female  FORMCHECKBOX Date of Birth: FORMTEXT      Address:Address:Tel:Home:  FORMTEXT       Work:  FORMTEXT       Cell:  FORMTEXT      Email: FORMTEXT       Section 2: Please list any medical problems and/or injuries you have experienced over the last 12 months (include ALL current conditions and all problems  minor or  major ):  FORMTEXT       Section 3: Please list ALL medicines that you are currently taking (include ALL pills, sprays, drops, inhalers, creams, patches, injections, suppositories, etc.):  FORMTEXT       Section 4: Please list any TUEs (Therapeutic Use Exemptions) Indicate if  applied for or  already granted:  FORMTEXT       Section 5 Please list ALL vitamins and/or supplements you are currently taking:  FORMTEXT       Section 6: Family Medical History  please list any conditions which occur in your immediate family (e.g. diabetes, heart disease, asthma, bleeding disorders..& .):  FORMTEXT       Section 7: Immunizations  please indicate whether you are immunized against the following: Tetanus/Diptheria:Yes  FORMCHECKBOX  / No  FORMCHECKBOX Date of Last Immunization: FORMTEXT      Hepatitis A:Yes  FORMCHECKBOX  / No  FORMCHECKBOX Date of Last Immunization: FORMTEXT      Hepatitis B:Yes  FORMCHECKBOX  / No  FORMCHECKBOX Date of Last Immunization: FORMTEXT      Flu Shot:Yes  FORMCHECKBOX  / No  FORMCHECKBOX Date of Last Immunization: FORMTEXT      Typhoid:Yes  FORMCHECKBOX  / No  FORMCHECKBOX Date of Last Immunization: FORMTEXT       Section8: Allergies  please indicate whether you have any known allergies, especially to any medicines:  FORMTEXT       Section 9: Dietary Requirements  please indicate any specific dietary requirements:  FORMTEXT       Section 10: Musculoskeletal System: Do you have an problems with your Neck?Yes  FORMCHECKBOX  / No  FORMCHECKBOX  Shoulders?Yes  FORMCHECKBOX  / No  FORMCHECKBOX  Back?Yes  FORMCHECKBOX  / No  FORMCHECKBOX  Knees?Yes  FORMCHECKBOX  / No  FORMCHECKBOX  Wrist? Yes  FORMCHECKBOX  / No  FORMCHECKBOX Please detail: FORMTEXT       Section 11: Eyes: Do you wear Glasses?Yes  FORMCHECKBOX  / No  FORMCHECKBOX Do you wear contacts?Yes  FORMCHECKBOX  / No  FORMCHECKBOX Any problems with your eyes? (e.g. squint, glaucoma, cataract) FORMTEXT       Section 12: Teeth: Do you have any current problems?Yes  FORMCHECKBOX  / No  FORMCHECKBOX If Yes, please detail FORMTEXT      Do you have any loose teeth,false teeth, caps, crowns?Yes  FORMCHECKBOX  / No  FORMCHECKBOX If Yes, please detail FORMTEXT       Section 13: Do you Smoke? Do you smoke?Yes  FORMCHECKBOX  / No  FORMCHECKBOX If Yes, maximum ever smoked per day FORMTEXT       Cigarettes  FORMCHECKBOX / Cigars  FORMCHECKBOX  Section 14: Do you use recreational drugs? Do you use recreational drugs (e.g. marijuana)Yes  FORMCHECKBOX  / No  FORMCHECKBOX If Yes, do you use themRarely  FORMCHECKBOX  / Occasionally  FORMCHECKBOX  / Regularly  FORMCHECKBOX  I declare that the information I have provided is complete and accurate. Divers Signature ______________________Date __________________________ ****For Divers Under 18 ONLY(signature of parent/guardian)**** Signed __________________________________ Date: _______________ Name  FORMTEXT       Relationship FORMTEXT       Parent FORMCHECKBOX  /Guardian FORMCHECKBOX  (please check) To be completDPRVXZ* : ֻvbJ5(hh ;CJOJQJ^JaJmH sH .h&Mh ;5CJOJQJ\^JaJmH sH &h&MhZ5OJQJ\^JmH sH (h25CJOJQJ\^JaJmH sH .h&MhZ5CJOJQJ\^JaJmH sH /h\15>*CJ KH$OJQJ\^JaJ mH sH 5hhZ5>*CJ KH$OJQJ\^JaJ mH sH hhZCJaJmH sH hhZmH sH jhhZUmH sH RTVXZ( * hccccccgdZ]kd%6$$Iflo0$ t 6Ph644 layt$$$h&P#$/@&Ifa$gd$h&P#$/Ifgd$$h&P#$/Ifa$gd * < d f \ NTkd7$$Ifl0$| t644 laytTkd 7$$Ifl0$| t644 layt $IfgdZ: < > R T V ` b f   " $ 8 : V ллcлGлл7j@8hh ;CJOJQJU^JaJmH sH 7jl7hh ;CJOJQJU^JaJmH sH ?jhh ;CJOJPJQJU^JaJmHnHo(sH u7j6hh ;CJOJQJU^JaJmH sH (hh ;CJOJQJ^JaJmH sH 1jhh ;CJOJQJU^JaJmH sH +hh ;CJOJQJ\^JaJmH sH V X Z \ ^ | ~    0 ʵʵcʵʵGcʵʵ7j:hh ;CJOJQJU^JaJmH sH ?jhh ;CJOJPJQJU^JaJmHnHo(sH u7j9hh ;CJOJQJU^JaJmH sH +hh ;CJOJQJ\^JaJmH sH (hh ;CJOJQJ^JaJmH sH 1jhh ;CJOJQJU^JaJmH sH 7j8hh ;CJOJQJU^JaJmH sH \ ^ | NTkd9$$Ifl0$| t644 layt $IfgdZTkd(9$$Ifl0$| t644 layt B x z NTkd<$$Ifl0$| t644 layt $IfgdZTkd\:$$Ifl0$| t644 layt0 2 4 > @ P R f h j t v x z ʪʕʕyʪʕcʕGʪʕc7jx<hh ;CJOJQJU^JaJmH sH +hh ;CJOJQJ\^JaJmH sH 7j;hh ;CJOJQJU^JaJmH sH (hh ;CJOJQJ^JaJmH sH ?jhh ;CJOJPJQJU^JaJmHnHo(sH u1jhh ;CJOJQJU^JaJmH sH 7j0;hh ;CJOJQJU^JaJmH sH  & N ]Q $$@&Ifgd ;@kdL=$$If%t%t%622 l4a $Ifgd ;gdZTkd<$$Ifl0$| t644 layt & ( < > @ J L b d x z | Ѽ郡eGe:j>h&Mh ;CJOJQJU\^JaJmH sH ;jh&Mh ;CJOJPJQJU\^JaJmH o(sH :j=h&Mh ;CJOJQJU\^JaJmH sH 4jh&Mh ;CJOJQJU\^JaJmH sH (h&Mh ;CJOJQJ^JaJmH sH .h&Mh ;5CJOJQJ\^JaJmH sH +h&Mh ;CJOJQJ\^JaJmH sH N P b DSkd>$$If0%|t%622 l4a $$@&Ifgd ; $Ifgd ;Skd>$$If0%|t%622 l4a ( * F H J ^ ` | ~ ǩǓǓuǓǓWǓǓ9ǩǓ:jAh&Mh ;CJOJQJU\^JaJmH sH :j@h&Mh ;CJOJQJU\^JaJmH sH :jR@h&Mh ;CJOJQJU\^JaJmH sH +h&Mh ;CJOJQJ\^JaJmH sH ;jh&Mh ;CJOJPJQJU\^JaJmH o(sH 4jh&Mh ;CJOJQJU\^JaJmH sH :jn?h&Mh ;CJOJQJU\^JaJmH sH   DSkd:A$$If0%|t%622 l4a $$@&Ifgd ; $Ifgd ;Skd?$$If0%|t%622 l4a 2hDSkdB$$If0%|t%622 l4a $$@&Ifgd ; $Ifgd ;SkdB$$If0%|t%622 l4a   "$.0@BVXZdfvxϱuW:jCh&Mh ;CJOJQJU\^JaJmH sH :jrCh&Mh ;CJOJQJU\^JaJmH sH ;jh&Mh ;CJOJPJQJU\^JaJmH o(sH :jBh&Mh ;CJOJQJU\^JaJmH sH +h&Mh ;CJOJQJ\^JaJmH sH 4jh&Mh ;CJOJQJU\^JaJmH sH hDBSkd>E$$If0%|t%622 l4a $Ifgd ;SkdZD$$If0%|t%622 l4a $$@&Ifgd ;JL`bdnpǩǓt_ǓAǩǓǓ:jFh&Mh ;CJOJQJU\^JaJmH sH (h&Mh ;CJOJQJ^JaJmH sH .h&Mh ;5CJOJQJ\^JaJmH sH  h&Mh ;+h&Mh ;CJOJQJ\^JaJmH sH ;jh&Mh ;CJOJPJQJU\^JaJmH o(sH 4jh&Mh ;CJOJQJU\^JaJmH sH :jDh&Mh ;CJOJQJU\^JaJmH sH JrtWSkd|F$$If0%|t%622 l4a $$@&Ifgd ; $Ifgd ;@kdE$$If%t%t%622 l4aLNjlnǩǓǓuǩǓǓWǓǓ9Ǔ:j(Ih&Mh ;CJOJQJU\^JaJmH sH :jHh&Mh ;CJOJQJU\^JaJmH sH :jGh&Mh ;CJOJQJU\^JaJmH sH +h&Mh ;CJOJQJ\^JaJmH sH ;jh&Mh ;CJOJPJQJU\^JaJmH o(sH 4jh&Mh ;CJOJQJU\^JaJmH sH :jFh&Mh ;CJOJQJU\^JaJmH sH  BDSkdDH$$If0%|t%622 l4a $$@&Ifgd ; $Ifgd ;Skd`G$$If0%|t%622 l4aDSkdJ$$If0%|t%622 l4a $$@&Ifgd ; $Ifgd ;SkdI$$If0%|t%622 l4a.0DFHRTdfz|~ϱuW:jKh&Mh ;CJOJQJU\^JaJmH sH :j`Kh&Mh ;CJOJQJU\^JaJmH sH ;jh&Mh ;CJOJPJQJU\^JaJmH o(sH :j Jh&Mh ;CJOJQJU\^JaJmH sH +h&Mh ;CJOJQJ\^JaJmH sH 4jh&Mh ;CJOJQJU\^JaJmH sH  VDSkdL$$If0%|t%622 l4a $$@&Ifgd ; $Ifgd ;SkdJ$$If0%|t%622 l4a^`bǩǓǓuǩǓnVA0!jh&Mh ;OJQJU^J(h&Mh ;CJOJQJ^JaJmH sH .h&Mh ;5CJOJQJ\^JaJmH sH  h&Mh ;:j,Mh&Mh ;CJOJQJU\^JaJmH sH +h&Mh ;CJOJQJ\^JaJmH sH ;jh&Mh ;CJOJPJQJU\^JaJmH o(sH 4jh&Mh ;CJOJQJU\^JaJmH sH :jHLh&Mh ;CJOJQJU\^JaJmH sH `e`gd&M3bw &#$$d%d&d'd+DU/NOPQgd ;gd ;SkdM$$If0%|t%622 l4a $$@&Ifgd ;bvxzε󮖁pcOp6pc0jh&Mh&MOJPJQJU^JmHnHu'jNh&Mh&MOJQJU^Jh&Mh&MOJQJ^J!jh&Mh&MOJQJU^J(h&Mh&MCJOJQJ^JaJmH sH .h&Mh&M5CJOJQJ\^JaJmH sH  h&Mh ;0jh&Mh ;OJPJQJU^JmHnHu!jh&Mh ;OJQJU^J'jNh&Mh ;OJQJU^Jh&Mh ;OJQJ^JDFHJLNPRTVgdZgd&M3bw &#$$d%d&d'd+DU/NOPQgd&M2ȷ}ȷi}Tȷ(h&M5CJOJQJ\^JaJmH sH 'jrOh&Mh&MOJQJU^J0jh&Mh&MOJPJQJU^JmHnHu'jNh&Mh&MOJQJU^Jh&Mh&MOJQJ^J!jh&Mh&MOJQJU^J(h&Mh&MCJOJQJ^JaJmH sH .h&Mh&M5CJOJQJ\^JaJmH sH h&Mh&MmH sH 246@BDFHVxz>ڴkVkD/(hh&MCJOJQJ^JaJmH sH "h&MCJOJQJ^JaJmH sH (h&M5CJOJQJ\^JaJmH sH .h&Mh&M5CJOJQJ\^JaJmH sH h2OJQJ^JmH sH h&MOJQJ^JmH sH (h&Mh&MCJOJQJ^JaJmH sH h&Mh&MOJQJ^J0jh&Mh&MOJPJQJU^JmHnHu!jh&Mh&MOJQJU^J'jOh&Mh&MOJQJU^J6 dPG $Ifgd9kdQ$$Ifl\$ 4 t0644 layt $Ifgd&Mgd&M>@\^`ln0ѵљш{gN0jhh&MOJPJQJU^JmHnHu'jFQhh&MOJQJU^Jhh&MOJQJ^J!jhh&MOJQJU^J7jPhh9CJOJQJU^JaJmH sH 7j^Phh9CJOJQJU^JaJmH sH (hh&MCJOJQJ^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH 024@B^`bʵʵʵ{gNʵ27jThh&MCJOJQJU^JaJmH sH 0jhh&MOJPJQJU^JmHnHu'jcShh&MOJQJU^Jhh&MOJQJ^J!jhh&MOJQJU^J7jRhh&MCJOJQJU^JaJmH sH (hh&MCJOJQJ^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH 7j{Rhh&MCJOJQJU^JaJmH sH d8nUL $Ifgd&MkdS$$Ifl\$ 4 t0644 layt $Ifgd9246np류kO7jVhh&MCJOJQJU^JaJmH sH 0jhh&MOJPJQJU^JmHnHu'jUhh&MOJQJU^Jhh&MOJQJ^J!jhh&MOJQJU^J7j Uhh&MCJOJQJU^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH (hh&MCJOJQJ^JaJmH sH <d^ULLL $Ifgd9 $Ifgd&MkdU$$Ifl\$ 4 t0644 layt<>RTV`bʵjʵNʵʵ27jFYhh&MCJOJQJU^JaJmH sH 7jXhh&MCJOJQJU^JaJmH sH 0jhh&MOJPJQJU^JmHnHu'jWhh&MOJQJU^Jhh&MOJQJ^J!jhh&MOJQJU^J(hh&MCJOJQJ^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH 7j)Whh&MCJOJQJU^JaJmH sH dfx0^ULLL $Ifgd9 $Ifgd&MkdX$$Ifl\$ 4 t0644 layt  ",.246`$͹ڠ뎀hSB5h&Mh&MOJQJ^J!jh&Mh&MOJQJU^J(h&Mh&MCJOJQJ^JaJmH sH .h&Mh&M5CJOJQJ\^JaJmH sH h&MOJQJ^JmH sH "h&MCJOJQJ^JaJmH sH 0jhh&MOJPJQJU^JmHnHu'jYhh&MOJQJU^Jhh&MOJQJ^J!jhh&MOJQJU^J(hh&MCJOJQJ^JaJmH sH 0246^YTYgdZgd&Mkd0Z$$Ifl\$ 4 t0644 layt$&(2468:x  "$(ZڴyڴeڴM8M8(hi5CJOJQJ\^JaJmH sH .h&Mhi5CJOJQJ\^JaJmH sH 'je[h&Mh&MOJQJU^J.h&Mh&M5CJOJQJ\^JaJmH sH h&MOJQJ^JmH sH (h&Mh&MCJOJQJ^JaJmH sH h&Mh&MOJQJ^J0jh&Mh&MOJPJQJU^JmHnHu!jh&Mh&MOJQJU^J'jZh&Mh&MOJQJU^J68:XZ $IfgdigdigdZgd&M3bw &#$$d%d&d'd+DU/NOPQgd&M  $Ifgdihkd[$$Ifl# t0644 la`ytZ   " * , H J L X Z v x z ~ iM҅7jQ^hhiCJOJQJU^JaJmH sH 7j]hhiCJOJQJU^JaJmH sH (hhiCJOJQJ^JaJmH sH 7j\hhiCJOJQJU^JaJmH sH 7j]\hhiCJOJQJU^JaJmH sH 1jhhiCJOJQJU^JaJmH sH (hhiCJOJQJ^JaJmH sH  " | {{ $Ifgdi{kdE]$$Ifl0H#TX t0644 la`yt| ~ {{ $Ifgdi{kd^$$Ifl0H#TX t0644 la`yt !!! !"!.!0!L!N!P!R!T!n!p!!ʵʵʌwʵ[ʵʵ?ʌwʵ7jQahhiCJOJQJU^JaJmH sH 7j`hhiCJOJQJU^JaJmH sH (hhiCJOJQJ^JaJmH sH hhiOJQJ^J7j_hhiCJOJQJU^JaJmH sH (hhiCJOJQJ^JaJmH sH 1jhhiCJOJQJU^JaJmH sH 7j]_hhiCJOJQJU^JaJmH sH  R!{{ $Ifgdi{kdE`$$Ifl0H#TX t0644 la`ytR!T!f!!{{ $Ifgdi{kda$$Ifl0H#TX t0644 la`yt!!!!!!!!!!!!!!!ʵʵʌwbQD0Q'jchhOJQJU^JhhOJQJ^J!jhhOJQJU^J(hhCJOJQJ^JaJmH sH (hhiCJOJQJ^JaJmH sH hhiOJQJ^J7jbhhiCJOJQJU^JaJmH sH (hhiCJOJQJ^JaJmH sH 1jhhiCJOJQJU^JaJmH sH 7j]bhhiCJOJQJU^JaJmH sH !!!"{{ $Ifgdi{kdEc$$Ifl0H#TX t0644 la`yt!""" "" "T"d"h"t"z""ɴu`uK6(hh&MCJOJQJ^JaJmH sH (h&M5CJOJQJ\^JaJmH sH (h5CJOJQJ\^JaJmH sH .h&Mh&M5CJOJQJ\^JaJmH sH "hCJOJQJ^JaJmH sH (h&MhiCJOJQJ^JaJmH sH (hhCJOJQJ^JaJmH sH hhOJQJ^J!jhhOJQJU^J0jhhOJPJQJU^JmHnHu " " "T"x"z"""zzqq $Ifgd9gd&Mgdi{kdSd$$Ifl0H#TX t0644 la`yt""""""""""4#6#R#T#V#b#d#####$$ѵљ}aL;!jhh&MOJQJU^J(hh&MCJOJQJ^JaJmH sH 7jfhh&MCJOJQJU^JaJmH sH 7jkfhh&MCJOJQJU^JaJmH sH 7j_ehh&MCJOJQJU^JaJmH sH 7jdhh&MCJOJQJU^JaJmH sH (hh&MCJOJQJ^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH "#,##{{ $Ifgd9{kde$$Ifl0H#TX t0644 la`yt##$.${{ $Ifgd9{kdSg$$Ifl0H#TX t0644 la`yt$$$ $*$,$0$x$$$$$$$$εΠs^sIsI4(hh&MCJOJQJ^JaJmH sH (h&M5CJOJQJ\^JaJmH sH (h5CJOJQJ\^JaJmH sH .h&Mh&M5CJOJQJ\^JaJmH sH (h&Mh&MCJOJQJ^JaJmH sH (hh&MCJOJQJ^JaJmH sH 0jhh&MOJPJQJU^JmHnHu!jhh&MOJQJU^J'jghh&MOJQJU^Jhh&MOJQJ^J.$0$x$$$<%zqq $Ifgd9gdZgd&M{kdah$$Ifl0H#TX t0644 la`yt$$% % %%%6%8%:%j%l%%%%%%&& &&*&ѵљш{gN= hh&MCJOJQJ^JaJ0jhh&MOJPJQJU^JmHnHu'jyjhh&MOJQJU^Jhh&MOJQJ^J!jhh&MOJQJU^J7jmihh&MCJOJQJU^JaJmH sH 7jhhh&MCJOJQJU^JaJmH sH (hh&MCJOJQJ^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH <%>%j%%{{ $Ifgd9{kdi$$Ifl0H#TX t0644 la`yt%%&^&{{ $Ifgd9{kdj$$Ifl0H#TX t0644 la`yt*&,&.&:&<&X&Z&\&`&&&&&&&&&&ʵʵʄsfRs9s0jhh&MOJPJQJU^JmHnHu'jmhh&MOJQJU^Jhh&MOJQJ^J!jhh&MOJQJU^J(hh&MCJOJQJ^JaJmH sH 7jkhh&MCJOJQJU^JaJmH sH (hh&MCJOJQJ^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH 7jkhh&MCJOJQJU^JaJmH sH ^&`&&&{{ $Ifgd9{kdol$$Ifl0H#TX t0644 la`yt&&&&& 'd'vv $Ifgd9gdZ{kd}m$$Ifl0H#TX t0644 la`yt&&&&&&&''0'2'4'@'B'^'`'b''ŰśmQmm5m7jnhh&MCJOJQJU^JaJmH sH 7jnhh&MCJOJQJU^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH (hh&MCJOJQJ^JaJmH sH (h&M5CJOJQJ\^JaJmH sH (h5CJOJQJ\^JaJmH sH .h&Mh&M5CJOJQJ\^JaJmH sH (h25CJOJQJ\^JaJmH sH h&MOJQJ^JmH sH d'f'''"({{{ $Ifgd9{kdn$$Ifl0H#TX t0644 la`yt'''''''''(((((( (!(#(%(N(ٌt_J2.h&Mh&M5CJOJQJ\^JaJmH sH (h5CJOJQJ\^JaJmH sH (hh&MCJOJQJ^JaJmH sH /jphh9CJOJQJU^JaJ/j phh9CJOJQJU^JaJ8jhh&MCJOJPJQJU^JaJmHnHu/johh&MCJOJQJU^JaJ hh&MCJOJQJ^JaJ)jhh&MCJOJQJU^JaJ"(#($(%(P(((vv $Ifgd9gdZ{kdp$$Ifl0H#TX t0644 la`ytN(P(o(((((((((((((((((o^I^1I/j shh9CJOJQJU^JaJ)jhh&MCJOJQJU^JaJ hh&MCJOJQJ^JaJ7jqhh&MCJOJQJU^JaJmH sH 7jqhh&MCJOJQJU^JaJmH sH 1jhh&MCJOJQJU^JaJmH sH (hh&MCJOJQJ^JaJmH sH +hh&MCJOJQJ\^JaJmH sH (h&M5CJOJQJ\^JaJmH sH (((){{ $Ifgd9{kdsr$$Ifl0H#TX t0644 la`yt(((((( ) )))))")k))***ڕhShS>(h6zh&MCJOJQJ^JaJmH sH (h&MhZCJOJQJ^JaJmH sH .h&MhZ5CJOJQJ\^JaJmH sH (h&M5CJOJQJ\^JaJmH sH (hh&MCJOJQJ^JaJmH sH /jshh9CJOJQJU^JaJ/jshh9CJOJQJU^JaJ)jhh&MCJOJQJU^JaJ hh&MCJOJQJ^JaJ)) )!)")k)l))))****<+zgd&MgdZ{kdgt$$Ifl0H#TX t0644 la`yt********* + + +"+$+.+0+:+<+J+L+h+j+l++++ѵфhфL7juh6zh&MCJOJQJU^JaJmH sH 7juuh6zh&MCJOJQJU^JaJmH sH "h&MCJOJQJ^JaJmH sH <jh6zh&MCJOJPJQJU^JaJmHnHsH u7jth6zh&MCJOJQJU^JaJmH sH (h6zh&MCJOJQJ^JaJmH sH 1jh6zh&MCJOJQJU^JaJmH sH +++++,2V`ʵmTmTmE0(h55CJOJQJ\^JaJmH sH jvhh1UmH sH 1hh15>*CJOJQJ\^JaJmH sH .hh15CJOJQJ\^JaJmH sH U1 *hh15CJOJQJ\^JaJmH sH (h&MhZCJOJQJ^JaJmH sH (h6zh&MCJOJQJ^JaJmH sH 1jh6zh&MCJOJQJU^JaJmH sH 7javh6zh&MCJOJQJU^JaJmH sH <+++46bdxsk$a$gdZgd5Tkd$$Ifl0$| t644 layt $$Ifa$gd $Ifgd5 $Ifgd1$a$gdZ ^`gd&M ed by the Diver s doctor: Doctor s name : Athlete s name:  EXAMINATION(S): DATEPlease Record Here Signature & Printed Name of Examiner HEIGHT cms WEIGHT kilograms BLOOD TESTS: CBC, Ferritin, B12, Mono Screen CONSENT FORM SIGNED for release of medical information to Team Doctor? YES / NO (please circle) ANNUAL MEDICAL SCREEN REVIEWED? MD Signature Date FURTHER INVESTIGATIONS RECOMMENDED: THERAPEUTIC USE EXEMPTION (TUE) NEEDED? YES / NO (please circle) COMPLETED YES / NO (please circle) Signature Date FIT FOR TRAVEL, TRAINING AND COMPETITION Signature Date NAME FORMTEXT       Contact Details of your Sport Science and Medicine Providers Please provide contact details of all the Sport Science and Medicine Providers that support you at Local and/or Regional Level. General Practitioner s (GP s) contact details: Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Local / Regional Sports Medicine Doctor (provide details if you use, or have used, a Sports Doctor): Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Local Physiotherapist (please provide details of the Physiotherapist(s) you have used, or would wish to use, local to you): Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Other Medical Experts (ie. Consultant / Specialist / Surgeon): Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Sport Massage Therapist (please provide details of the Massage Therapist(s) you have used, or would wish to use, local to you): Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Strength & Conditioning Coach (please provide details of the S&C coach you have used, or would wish to use, local to you): Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Other Local / Regional Sport Science / Medicine Provider (i.e. psychologist, dietician, physiologist, biomechanists) Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Other Local / Regional Sport Science / Medicine Provider (i.e. psychologist, dietician, physiologist, biomechanists) Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Other Local / Regional Sport Science / Medicine Provider (i.e. psychologist, dietician, physiologist, biomechanists) Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Other Local / Regional Sport Science / Medicine Provider (i.e. psychologist, dietician, physiologist, biomechanists) Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Other Local / Regional Sport Science / Medicine Provider (i.e. psychologist, dietician, physiologist, biomechanists) Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        Other Local / Regional Sport Science / Medicine Provider (i.e. psychologist, dietician, physiologist, biomechanists) Name:  FORMTEXT       Address: FORMTEXT       Tel: FORMTEXT       (Work) Email:  FORMTEXT        "@BFJ`bdήwbLbw6w+hSLhZ>*CJOJQJ^JaJmH sH +h&MhSLCJH*OJQJ^JaJmH sH (h&MhSLCJOJQJ^JaJmH sH "hSLCJOJQJ^JaJmH sH "h1CJOJQJ^JaJmH sH %hSL>*CJOJQJ^JaJmH sH (h&MhZCJOJQJ^JaJmH sH h&MhZCJaJ.h&MhZ5CJOJQJ\^JaJmH sH 1hSLh55>*CJOJQJ\^JaJmH sH  "$&(*,.02468:<>@BD $$Ifa$gdZ $$Ifa$gdZ$a$gdZDFdf46~~~v~n~i~gd1$a$gd1$a$gd$a$gdZakd\$$IfF~$X 6    22 l4a $$Ifa$gdZ $$Ifa$gdZ v~:pr"$,.BٱƞٱmX(h15CJOJQJ\^JaJmH sH 1jh15CJOJQJU\^JaJmH sH .h&MhZ5CJOJQJ\^JaJmH sH %hZ>*CJOJQJ^JaJmH sH (h&Mh1CJOJQJ^JaJmH sH %h1>*CJOJQJ^JaJmH sH "h1CJOJQJ^JaJmH sH (h&MhZCJOJQJ^JaJmH sH :< $Z\<>rt $Ifgd.y+gdZ$a$gdZ$a$gdZ$a$gd1$a$gdZgd1BDFPRXZ\ǪǕ}kVG2 "hZCJOJQJ^JaJmH sH (h&MhZCJOJQJ^JaJmH sH h&MhZCJaJmH sH )h1hZ5>*OJQJ\^JmH sH #h15>*OJQJ\^JmH sH .h&MhZ5CJOJQJ\^JaJmH sH (h15CJOJQJ\^JaJmH sH 8jh15CJOJQJU\^JaJmHnHsH u1jh15CJOJQJU\^JaJmH sH =j h1h15CJOJQJU\^JaJmH sH  <JL`bdnprT6T:jh.y+h.y+CJOJQJU\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH :jh.y+h.y+CJOJQJU\^JaJmH sH 4jh.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH .h.y+h.y+5CJOJQJ\^JaJmH sH (h.y+5CJOJQJ\^JaJmH sH "hmOVCJOJQJ^JaJmH sH  "$.0<>@ 0ǩǓǓuǩǓbMbǓ(h.y+5CJOJQJ\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH :jh.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH 4jh.y+h.y+CJOJQJU\^JaJmH sH :jnh.y+h.y+CJOJQJU\^JaJmH sH >@B BD|~ <Skd2$$If0H$622 l4a $Ifgd.y+024>@TVjlnxzǩǓǓuǩǓǓWǩǓǓ9:jh.y+h.y+CJOJQJU\^JaJmH sH :jFh.y+h.y+CJOJQJU\^JaJmH sH :jаh.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH 4jh.y+h.y+CJOJQJU\^JaJmH sH :jZh.y+h.y+CJOJQJU\^JaJmH sH  <,.0:<PRfhjt屠uuW9:jh.y+h.y+CJOJQJU\^JaJmH sH :jh.y+h.y+CJOJQJU\^JaJmH sH .h.y+h.y+5CJOJQJ\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH  h.y+h.y+CJOJQJ^JaJ+h.y+h.y+CJOJQJ\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH 4jh.y+h.y+CJOJQJU\^JaJmH sH < >@xz JL $Ifgd.y+tv ϱubbM(h.y+5CJOJQJ\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH :jh.y+h.y+CJOJQJU\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH :jh.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH 4jh.y+h.y+CJOJQJU\^JaJmH sH *,.8:Z\prǩǓǓuǩǓǓWǩǓǓ9:jܵh.y+h.y+CJOJQJU\^JaJmH sH :jfh.y+h.y+CJOJQJU\^JaJmH sH :jh.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH 4jh.y+h.y+CJOJQJU\^JaJmH sH :jzh.y+h.y+CJOJQJU\^JaJmH sH rt~ r|屠yaNa0:j¶h.y+h.y+CJOJQJU\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH .h.y+h.y+5CJOJQJ\^JaJmH sH (h.y+5CJOJQJ\^JaJmH sH #h.y+h.y+CJOJQJ\^JaJ h.y+h.y+CJOJQJ^JaJ+h.y+h.y+CJOJQJ\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH 4jh.y+h.y+CJOJQJU\^JaJmH sH NP $Ifgd.y+SkdR$$If0H$622 l4a.02<>^`tvxϱuWDD%h.y+CJOJQJ\^JaJmH sH :j$h.y+h.y+CJOJQJU\^JaJmH sH :jh.y+h.y+CJOJQJU\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH :j8h.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH 4jh.y+h.y+CJOJQJU\^JaJmH sH $pzժՏqSՏ5S:jh.y+h.y+CJOJQJU\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH :jh.y+h.y+CJOJQJU\^JaJmH sH 4jh.y+h.y+CJOJQJU\^JaJmH sH .h.y+h.y+5CJOJQJ\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH (h.y+5CJOJQJ\^JaJmH sH NP $Ifgd1Skdr$$If0H$622 l4a $Ifgd.y+.02<>^`tvx ϱud`N9(h.y+5CJOJQJ\^JaJmH sH #h.y+h.y+CJOJQJ\^JaJh.y+ h.y+h.y+CJOJQJ^JaJ:jh.y+h.y+CJOJQJU\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH :jh.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH 4jh.y+h.y+CJOJQJU\^JaJmH sH  "$.0PRfֻֻ֝aֻCֻ:jλh.y+h1CJOJQJU\^JaJmH sH :jXh.y+h1CJOJQJU\^JaJmH sH ;jh.y+h1CJOJPJQJU\^JaJmH o(sH :jh.y+h1CJOJQJU\^JaJmH sH 4jh.y+h1CJOJQJU\^JaJmH sH +h.y+h1CJOJQJ\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH @Brt02prtvSkd$$If0H$622 l4a $Ifgd.y+ $Ifgd1fhjtvrǩǓjWBWǓ(h.y+5CJOJQJ\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH %h1CJOJQJ\^JaJmH sH +h.y+h1CJOJQJ\^JaJmH sH ;jh.y+h1CJOJPJQJU\^JaJmH o(sH 4jh.y+h1CJOJQJU\^JaJmH sH :jDh.y+h1CJOJQJU\^JaJmH sH   @BVXǩǓǓuǩǓǓWǩǓǓ9:jh.y+h1CJOJQJU\^JaJmH sH :jh.y+h1CJOJQJU\^JaJmH sH :j0h.y+h1CJOJQJU\^JaJmH sH +h.y+h1CJOJQJ\^JaJmH sH ;jh.y+h1CJOJPJQJU\^JaJmH o(sH 4jh.y+h1CJOJQJU\^JaJmH sH :jh.y+h1CJOJQJU\^JaJmH sH XZdfrtnp屠w]wCww3jh.y+h.y+CJOJPJQJU\^JaJo(2jh.y+h.y+CJOJQJU\^JaJ,jh.y+h.y+CJOJQJU\^JaJ#h.y+h.y+CJOJQJ\^JaJ h.y+h1CJOJQJ^JaJ+h.y+h1CJOJQJ\^JaJmH sH ;jh.y+h1CJOJPJQJU\^JaJmH o(sH 4jh.y+h1CJOJQJU\^JaJmH sH v`b bdfPRNP $Ifgd.y+ .0DFHRTdfP^ϵϣϣϵϣϣoϵϣ\F\F+h.y+h.y+CJOJQJ\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH 2jdh.y+h.y+CJOJQJU\^JaJ2jh.y+h.y+CJOJQJU\^JaJ#h.y+h.y+CJOJQJ\^JaJ3jh.y+h.y+CJOJPJQJU\^JaJo(,jh.y+h.y+CJOJQJU\^JaJ2jxh.y+h.y+CJOJQJU\^JaJ^`tvx 4ϱuW:jh.y+h.y+CJOJQJU\^JaJmH sH :jPh.y+h.y+CJOJQJU\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH :jh.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH 4jh.y+h.y+CJOJQJU\^JaJmH sH 468BDRLNbdfprǩǓjPj6jj3jh.y+h.y+CJOJPJQJU\^JaJo(2j"h.y+h.y+CJOJQJU\^JaJ,jh.y+h.y+CJOJQJU\^JaJ#h.y+h.y+CJOJQJ\^JaJ+h.y+h.y+CJOJQJ\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH 4jh.y+h.y+CJOJQJU\^JaJmH sH :j<h.y+h.y+CJOJQJU\^JaJmH sH PRT>@tv@BD.0df $Ifgd.y+Skd$$If0H$622 l4a "$&02BD.<ϵϣϣϵϣϣoϵϣ\F\F+h.y+h.y+CJOJQJ\^JaJmH sH %h.y+CJOJQJ\^JaJmH sH 2jh.y+h.y+CJOJQJU\^JaJ2jh.y+h.y+CJOJQJU\^JaJ#h.y+h.y+CJOJQJ\^JaJ3jh.y+h.y+CJOJPJQJU\^JaJo(,jh.y+h.y+CJOJQJU\^JaJ2jh.y+h.y+CJOJQJU\^JaJ<>RTV`bvxϱuW:jh.y+h.y+CJOJQJU\^JaJmH sH :jph.y+h.y+CJOJQJU\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH :jh.y+h.y+CJOJQJU\^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH 4jh.y+h.y+CJOJQJU\^JaJmH sH ,.024gdRGb$a$gdZSkd$$If0H$622 l4a $Ifgd.y+ "024ǩǓz h&Mh!"h.y+CJOJQJ^JaJmH sH +h.y+h.y+CJOJQJ\^JaJmH sH ;jh.y+h.y+CJOJPJQJU\^JaJmH o(sH 4jh.y+h.y+CJOJQJU\^JaJmH sH :j\h.y+h.y+CJOJQJU\^JaJmH sH 21h:p2/ =!"#$% %6Dds\  C 8A DPC color 1inchRu5 5]HQ5D FI5 5]HJFIFLEAD Technologies Inc. V1.01  }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyzw!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz\ ? (i_گF xUIrtoèz-II\m^$|#uq9p5W(^ܭOMZo|Ï q|ukJ.5r/ej%K*JNG׽(<Ξ'Ya_`:v`o+ @P@P'|'NEk Fqhu& l뉂>,Di&H"-n ^:΢JNnܜJ=\w{v0&m˳,yP6(*Ī:Re*ܾʜ!RpZJ{ZαxwGuj;F_V. [{ 3Lr 6K# ڇQ NMFNRodIx<&'pte_N P^Zgtu(+G'68Z·jψ|omo D.o,;M!,4$Pd*1!)Ni+Te*{+JNIw+4dxe"cަ~pD:#Ǟ VxƦm˕qWiCѻ9>j!O8я- [OžӮUZ)k:gtX$gֵf+-7HH5 Ok Hd?^jtT}yRn1dod4jb)ex*a0qXA%O:EY8ҡF Yԫ8C 1}]i? (?8~+imw{Y֢ <9M:OS6> $CEG N*nDXM8jno.3reG9j{:=+buiVe԰_E3Ŀ$EKXRO` &Vk}\\AsCkkxU5xw-oGu]/\5GQu 'ŚO]x?]IuKkdN 'ZpXNpi8WwVMvRN.T~W8kr + e8&_ŒO: 4J"SҝL7F:g*J'!a|/$kچk𑤑DXh/SiZnnIS-!u̖iimu+c\4rj|`'R)--7nm2ø XJ5R|&yX`k֯YxU&!N4F pc+-A@P@omkW_?kֿӼIqaz\i,mlⲾDElncE$:Qxaҭn>N/$k~YEꞟE>iUupqڔ;NIj'9ХY9A(W'*|'[8i9|`%/#z,~l^-h c$$@$p)*~.NSVO_9A#4x|1,ipފQWiJ#+{xZ)> oZkԴ__?P;_<$ݢ3eH }? {QKܯ?S K8~YZj擵v{|SeᏈ_<{kw!ω4[I5+{Kú9K=1KCcH$S1J2Q굄# -{J-|?br O S_qN7 +)Mgf?M~'R4 =|w ,:Fxv-#L$ OUa R\KRw?ΖՔaUKa(ť{O-_4RM?x8nጣ bh RSb18׭NRqi*4i}bIBNN|S%L·?K'%$M0I-ljL-xnI=$qoq%^&cTOM;o6`=g9ok<cc/԰\S49 ڰzipOF=~CC᭯=[6u`fO\ei ;[[ Z :asF Rr]I_޵h[58k˩m,~ OHPTVpғZ^$JnG~E|z_4O :Pkx+s[]h57~-[,&OdMQZ 8vaQtb*+F'_"xW燼 fT؜8V.+9c(ҧX< 5E)3c2>W:/؅@nŮ(]Gߴ8./k^whXPri=9-yʿA@Kh*e-ާgGyQ[?xq|,W~ؤyUÔ#{Q$/+JAM7Z 4(TkwUj0F0N.%[ߗV>o< ƿ/# Qo져Mp`v)u kJmwv4[_vveCZX:R;5hT*rqSJ/<4;% 58ׇfmYACSUϞUþo5hV5u) N:.}jVai:}k#Csg{gr5R*+)V+ZpnViOT=w 01XJX\M8UZRZS*S(NN2qi6To+#!ZIp}|,2;|w:O3[[h1ނ u#n4;iF`_J\gQ5+UfI4~U~^=ƧJTc?Z׾#.ggԥ~!_e ̎ZxnJŢa"N8bҩR J:^kMovw -ϣ6gx{2E:.*a+IqӨ8ZnO4eB!ӧfIſ造~yX:>~ԯƾe㫋[#gwc7 n5$wZ&){ZU§UJJqV,ZX4{nQY6?%qƊ2SFy]:OT^WG-u*' ExSR~?}#oʍ>Ad~:%֧Cg⥍mUXмaX["Xs]ike<+ RG᝴vVewPj8K XG \υ؜2s&FJd9P ] ISP}o_7.hW)M̱]Z\D0RI,&)H5iURTAө>Mş>mcv%^ZmN$JUatQTS9:C(|t*tsB,=Yس|3zID|rʇ0D Vڵjlו_Hчa#R 2ۋM*ZW\9Ӛ(L<-?n[ux}ogsV|^M+O G>ћ^D_Vp|ҔqtjQNxJ\Kt_f}O韣Ni9QXdэ ӛ\RѹBi(C*tom?LdoJoZĿW7~Kqk0;dM_TѼ/:c%g+"1b!EOg?mfV+w8Æ8kKP槌ǵ|t(JToX|,sR5 ,7i:Vcgize}V})ogccglPĊjTa)F1I$KDZ$-bTbq'VZJjԓJ*MΤܧ97)II.S2 ??@o=/kx5K*bhEުc{٬WK!/`s<&P 88SZ_\a4knH)W )S)ӂo[SpIV*ͅ|G9o?ď?!#ټZmJBwXj̈g="n"+oC _(JU9i{nܝտ%wd|}3z،:񠵧:X;Օ*Ri')%KᏍ$~|KkO<#ɩjiuWWΑ>獟K@_cD# K ӧnk?~'S8s 8u ӍxVUѧRSHMBt \$W? _:军kw>7OzFTE-'"mO¿ o/&:]"'ΨlHN|J-_6ݏ #|] ]f|ulDN0qɺ%R`76׻~S]x῍1Y߶.kVКh]uD Z-eI6 uRԬ+5h [ܛH∧`ժVoggϙ(=5?A{VEdxe c#FNRZ^:qIFQKt?}#oP@|H؟?e=O᥇ůJm~'^ֺfhkZfez(#R=t RD$ "Ɠþ1W)td {o#b)b z++) .㓕(EIJ-4WM=kfѮkV֥U yƥ*(TRRԡ8I)FQjQM4a;|j4 𕯆|`KB*L_x8iviyj`KHt(akxEN4K({(rZͨ;$k${,mLhcZTic><::ʊsT_j'>X?[5?" md:~m;O|Y3gI\4)ier ^OP0k5Dž{#?Ȏe\/?~3Ѧxe֟Ij-߅xR+xP~-/w"B> / sC6|R/O7㨬L<;/ ?jhj65  MmaBM&i4՚kKuMNJ)գRTjєg Nӌ((-'&i4$!?_pG-9tM'ÿ:mOl>$6WMs,-K,3N:1TS(Gh*1^$ӏ1*;3b3mn_iVS*VS.XF04d8O  ;|Gm 3wm \rHV,bFh5 !oǏLmύ<jZ!Yx> 2**ȮUlm& $gA <=1*? K F?W]ZuW >%|'Ze VL&MpCoGFKqi`D?F P!|AOE}OQ|̺~uqq}Yt|cؾ"~ձi?dkMcƟ_~UP,ڮuu"h(%ֿi;bg,6V9;=[FW/> gm7mcq@N.]uosꚔzu{ #GN-5c#-χQ(8n'o+o+εk l>C߄z]qOwqOeq&m: KOX{x,}",3g|txO|O_c#YUo{x{AZmLJ˝>y$n9"gFJ6 ??:᧏d_mli,LbH5; |=4nȇM^YN+m5U [wVow-ΛZXj6ScwsY^z̺|J#Vzko{G7jiwﵺWCoq 'b}Nk0SK|-wOW{C X{>P%Py4c3gt &⍾C:o(gy+12iL? qQ6߈ Qȃ6kxrV">9𗈮 Zh2co{H卾A΀ (c~Կ6xU_| 㟉5;}m_COëPקA4frM*~ȻҾ$O'>8?|/>R> ˽7Z/57GMO'$6ʬl3rW/gn^|"u?xN_ouۏk yK/2\ Gcᶉ SXGI~:{o OxkEYV-]M6"CG)i{Go7gYFϏΫ-x{ψ !;WQ{*'F+%ţ6G6c>\Nľ _zlW:Gt S.%ƩѵI5{Ű?m7ǗdՓPRxSH-to@,1"solQr|:׎?Fr|-~cOoou{{7hmaft^Q^[.6V?+?:ǃߵo}᫫K|Q|%BHQ:փK@Mxׯe\i/acaq5߂CS/Ԭ>e)4B-'1ogo;$Wx~"ӆ*x-:?cK 'ڑ&`}6o-ϋwzԾiDqṭB~x K../&h8UmoOWMP~]|??gO?uˋ]>k쟉2]^NXۏ*ȷ ۝ )HxƿU+QO Ů헂?,Z\%߈N ѠBFJ2||OgFC~*>!Ox R0i&`G52^3om>&#┇K8'f :Ut=ıaԬsO,BHH rE' j&]KOQho/f+Hkbˈ+o$9P@ߴ힛pmy)29R~"ڊLlI+^yQiخ20ʊ 6/t O~ij-R|5աJ]fB-tqԺ3jWO}$?i)%4com?<d/_/~ xYmோ-ľ5G$5߆4H~(mLVi6X|]/_^-x񶏬|u]b hh|ZE͖ w俼U1(|xCΡZkx3TZ<]Os}S[Vnbkcy ~2ksq ~~"=2O ti挖BmJ|fAry)"m G߲oĿڢ6žjxKW~*J[ t9.tx?Þn/m<9Ziߋ8!Kh.'hZi`v(|Ώ>2]_|>_Eh&~7_Cs|3OZjEаR0#;(| ( ( (?q$$If!vh55#v#v:V lo t 6Ph655yttDText2^$$If!vh5|5#v|#v:V l t65|5yttDText1^$$If!vh5|5#v|#v:V l t65|5yttDeCheck1tDeCheck2^$$If!vh5|5#v|#v:V l t65|5yttDText1^$$If!vh5|5#v|#v:V l t65|5yt^$$If!vh5|5#v|#v:V l t65|5yttDText2tDText2tDText2^$$If!vh5|5#v|#v:V l t65|5yttDText2^$$If!vh5|5#v|#v:V l t65|5ytX$$If!vh5t%#vt%:V t%65t%22 l4 tDText2n$$If!vh5|5#v|#v:V t%65|522 l4 tDText2n$$If!vh5|5#v|#v:V t%65|522 l4 tDText1n$$If!vh5|5#v|#v:V t%65|522 l4 tDeCheck1tDeCheck2n$$If!vh5|5#v|#v:V t%65|522 l4 tDText1n$$If!vh5|5#v|#v:V t%65|522 l4 n$$If!vh5|5#v|#v:V t%65|522 l4 tDText2tDText2tDText2n$$If!vh5|5#v|#v:V t%65|522 l4 tDText2n$$If!vh5|5#v|#v:V t%65|522 l4 X$$If!vh5t%#vt%:V t%65t%22 l4 tDText2n$$If!vh5|5#v|#v:V t%65|522 l4 tDText2n$$If!vh5|5#v|#v:V t%65|522 l4 tDText1n$$If!vh5|5#v|#v:V t%65|522 l4 tDeCheck1tDeCheck2n$$If!vh5|5#v|#v:V t%65|522 l4 tDText1n$$If!vh5|5#v|#v:V t%65|522 l4 n$$If!vh5|5#v|#v:V t%65|522 l4 tDText2tDText2tDText2n$$If!vh5|5#v|#v:V t%65|522 l4 tDText2n$$If!vh5|5#v|#v:V t%65|522 l4 vDText34vDText34vDText34vDText34vDText34tDeCheck3tDeCheck4vDText34$$If!vh555 54 #v#v#v #v4 :V l t06555 54 yttDeCheck3tDeCheck4vDText34$$If!vh555 54 #v#v#v #v4 :V l t06555 54 yttDeCheck3tDeCheck4vDText34$$If!vh555 54 #v#v#v #v4 :V l t06555 54 yttDeCheck3tDeCheck4vDText34$$If!vh555 54 #v#v#v #v4 :V l t06555 54 yttDeCheck3tDeCheck4vDText34$$If!vh555 54 #v#v#v #v4 :V l t06555 54 ytvDText34vDText34$$If`!vh5 #v :V l t065 a`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`ytvDText34$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`ytvDText34$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`ytvDText34$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`ytvDText34$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`ytvDText34tDeCheck6tDeCheck5$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck3tDeCheck4$$If`!vh5T5X#vT#vX:V l t065T5Xa`yttDeCheck7tDeCheck8tDeCheck9$$If`!vh5T5X#vT#vX:V l t065T5Xa`ytvDText35vDText35vDeCheck11vDeCheck12%6DdsPL\  C 8A DPC color 1inchRu5 5]HQ5w FI5 5]HJFIFLEAD Technologies Inc. V1.01  }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyzw!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz\ ? (i_گF xUIrtoèz-II\m^$|#uq9p5W(^ܭOMZo|Ï q|ukJ.5r/ej%K*JNG׽(<Ξ'Ya_`:v`o+ @P@P'|'NEk Fqhu& l뉂>,Di&H"-n ^:΢JNnܜJ=\w{v0&m˳,yP6(*Ī:Re*ܾʜ!RpZJ{ZαxwGuj;F_V. [{ 3Lr 6K# ڇQ NMFNRodIx<&'pte_N P^Zgtu(+G'68Z·jψ|omo D.o,;M!,4$Pd*1!)Ni+Te*{+JNIw+4dxe"cަ~pD:#Ǟ VxƦm˕qWiCѻ9>j!O8я- [OžӮUZ)k:gtX$gֵf+-7HH5 Ok Hd?^jtT}yRn1dod4jb)ex*a0qXA%O:EY8ҡF Yԫ8C 1}]i? (?8~+imw{Y֢ <9M:OS6> $CEG N*nDXM8jno.3reG9j{:=+buiVe԰_E3Ŀ$EKXRO` &Vk}\\AsCkkxU5xw-oGu]/\5GQu 'ŚO]x?]IuKkdN 'ZpXNpi8WwVMvRN.T~W8kr + e8&_ŒO: 4J"SҝL7F:g*J'!a|/$kچk𑤑DXh/SiZnnIS-!u̖iimu+c\4rj|`'R)--7nm2ø XJ5R|&yX`k֯YxU&!N4F pc+-A@P@omkW_?kֿӼIqaz\i,mlⲾDElncE$:Qxaҭn>N/$k~YEꞟE>iUupqڔ;NIj'9ХY9A(W'*|'[8i9|`%/#z,~l^-h c$$@$p)*~.NSVO_9A#4x|1,ipފQWiJ#+{xZ)> oZkԴ__?P;_<$ݢ3eH }? {QKܯ?S K8~YZj擵v{|SeᏈ_<{kw!ω4[I5+{Kú9K=1KCcH$S1J2Q굄# -{J-|?br O S_qN7 +)Mgf?M~'R4 =|w ,:Fxv-#L$ OUa R\KRw?ΖՔaUKa(ť{O-_4RM?x8nጣ bh RSb18׭NRqi*4i}bIBNN|S%L·?K'%$M0I-ljL-xnI=$qoq%^&cTOM;o6`=g9ok<cc/԰\S49 ڰzipOF=~CC᭯=[6u`fO\ei ;[[ Z :asF Rr]I_޵h[58k˩m,~ OHPTVpғZ^$JnG~E|z_4O :Pkx+s[]h57~-[,&OdMQZ 8vaQtb*+F'_"xW燼 fT؜8V.+9c(ҧX< 5E)3c2>W:/؅@nŮ(]Gߴ8./k^whXPri=9-yʿA@Kh*e-ާgGyQ[?xq|,W~ؤyUÔ#{Q$/+JAM7Z 4(TkwUj0F0N.%[ߗV>o< ƿ/# Qo져Mp`v)u kJmwv4[_vveCZX:R;5hT*rqSJ/<4;% 58ׇfmYACSUϞUþo5hV5u) N:.}jVai:}k#Csg{gr5R*+)V+ZpnViOT=w 01XJX\M8UZRZS*S(NN2qi6To+#!ZIp}|,2;|w:O3[[h1ނ u#n4;iF`_J\gQ5+UfI4~U~^=ƧJTc?Z׾#.ggԥ~!_e ̎ZxnJŢa"N8bҩR J:^kMovw -ϣ6gx{2E:.*a+IqӨ8ZnO4eB!ӧfIſ造~yX:>~ԯƾe㫋[#gwc7 n5$wZ&){ZU§UJJqV,ZX4{nQY6?%qƊ2SFy]:OT^WG-u*' ExSR~?}#oʍ>Ad~:%֧Cg⥍mUXмaX["Xs]ike<+ RG᝴vVewPj8K XG \υ؜2s&FJd9P ] ISP}o_7.hW)M̱]Z\D0RI,&)H5iURTAө>Mş>mcv%^ZmN$JUatQTS9:C(|t*tsB,=Yس|3zID|rʇ0D Vڵjlו_Hчa#R 2ۋM*ZW\9Ӛ(L<-?n[ux}ogsV|^M+O G>ћ^D_Vp|ҔqtjQNxJ\Kt_f}O韣Ni9QXdэ ӛ\RѹBi(C*tom?LdoJoZĿW7~Kqk0;dM_TѼ/:c%g+"1b!EOg?mfV+w8Æ8kKP槌ǵ|t(JToX|,sR5 ,7i:Vcgize}V})ogccglPĊjTa)F1I$KDZ$-bTbq'VZJjԓJ*MΤܧ97)II.S2 ??@o=/kx5K*bhEުc{٬WK!/`s<&P 88SZ_\a4knH)W )S)ӂo[SpIV*ͅ|G9o?ď?!#ټZmJBwXj̈g="n"+oC _(JU9i{nܝտ%wd|}3z،:񠵧:X;Օ*Ri')%KᏍ$~|KkO<#ɩjiuWWΑ>獟K@_cD# K ӧnk?~'S8s 8u ӍxVUѧRSHMBt \$W? _:军kw>7OzFTE-'"mO¿ o/&:]"'ΨlHN|J-_6ݏ #|] ]f|ulDN0qɺ%R`76׻~S]x῍1Y߶.kVКh]uD Z-eI6 uRԬ+5h [ܛH∧`ժVoggϙ(=5?A{VEdxe c#FNRZ^:qIFQKt?}#oP@|H؟?e=O᥇ůJm~'^ֺfhkZfez(#R=t RD$ "Ɠþ1W)td {o#b)b z++) .㓕(EIJ-4WM=kfѮkV֥U yƥ*(TRRԡ8I)FQjQM4a;|j4 𕯆|`KB*L_x8iviyj`KHt(akxEN4K({(rZͨ;$k${,mLhcZTic><::ʊsT_j'>X?[5?" md:~m;O|Y3gI\4)ier ^OP0k5Dž{#?Ȏe\/?~3Ѧxe֟Ij-߅xR+xP~-/w"B> / sC6|R/O7㨬L<;/ ?jhj65  MmaBM&i4՚kKuMNJ)գRTjєg Nӌ((-'&i4$!?_pG-9tM'ÿ:mOl>$6WMs,-K,3N:1TS(Gh*1^$ӏ1*;3b3mn_iVS*VS.XF04d8O  ;|Gm 3wm \rHV,bFh5 !oǏLmύ<jZ!Yx> 2**ȮUlm& $gA <=1*? K F?W]ZuW >%|'Ze VL&MpCoGFKqi`D?F P!|AOE}OQ|̺~uqq}Yt|cؾ"~ձi?dkMcƟ_~UP,ڮuu"h(%ֿi;bg,6V9;=[FW/> gm7mcq@N.]uosꚔzu{ #GN-5c#-χQ(8n'o+o+εk l>C߄z]qOwqOeq&m: KOX{x,}",3g|txO|O_c#YUo{x{AZmLJ˝>y$n9"gFJ6 ??:᧏d_mli,LbH5; |=4nȇM^YN+m5U [wVow-ΛZXj6ScwsY^z̺|J#Vzko{G7jiwﵺWCoq 'b}Nk0SK|-wOW{C X{>P%Py4c3gt &⍾C:o(gy+12iL? qQ6߈ Qȃ6kxrV">9𗈮 Zh2co{H卾A΀ (c~Կ6xU_| 㟉5;}m_COëPקA4frM*~ȻҾ$O'>8?|/>R> ˽7Z/57GMO'$6ʬl3rW/gn^|"u?xN_ouۏk yK/2\ Gcᶉ SXGI~:{o OxkEYV-]M6"CG)i{Go7gYFϏΫ-x{ψ !;WQ{*'F+%ţ6G6c>\Nľ _zlW:Gt S.%ƩѵI5{Ű?m7ǗdՓPRxSH-to@,1"solQr|:׎?Fr|-~cOoou{{7hmaft^Q^[.6V?+?:ǃߵo}᫫K|Q|%BHQ:փK@Mxׯe\i/acaq5߂CS/Ԭ>e)4B-'1ogo;$Wx~"ӆ*x-:?cK 'ڑ&`}6o-ϋwzԾiDqṭB~x K../&h8UmoOWMP~]|??gO?uˋ]>k쟉2]^NXۏ*ȷ ۝ )HxƿU+QO Ů헂?,Z\%߈N ѠBFJ2||OgFC~*>!Ox R0i&`G52^3om>&#┇K8'f :Ut=ıaԬsO,BHH rE' j&]KOQho/f+Hkbˈ+o$9P@ߴ힛pmy)29R~"ڊLlI+^yQiخ20ʊ 6/t O~ij-R|5աJ]fB-tqԺ3jWO}$?i)%4com?<d/_/~ xYmோ-ľ5G$5߆4H~(mLVi6X|]/_^-x񶏬|u]b hh|ZE͖ w俼U1(|xCΡZkx3TZ<]Os}S[Vnbkcy ~2ksq ~~"=2O ti挖BmJ|fAry)"m G߲oĿڢ6žjxKW~*J[ t9.tx?Þn/m<9Ziߋ8!Kh.'hZi`v(|Ώ>2]_|>_Eh&~7_Cs|3OZjEаR0#;(| ( ( (?^$$If!vh55|#v#v|:V l t655|yt$$If!vh5H55~ #vH#v#v~ :V 65X55 / /  / 22 l4 vDText36vDText35vDText35vDText35vDText35vDText35vDText35vDText35vDText35n$$If!vh55#v:V 65/ 22 l4 vDText35vDText35vDText35vDText35vDText35vDText35vDText35vDText35n$$If!vh55#v:V 65/ 22 l4 vDText35vDText35vDText35vDText35vDText35vDText35vDText35vDText35n$$If!vh55#v:V 65/ 22 l4 vDText35vDText35vDText35vDText35vDText35vDText35vDText35vDText35n$$If!vh55#v:V 65/ 22 l4 vDText35vDText35vDText35vDText35vDText35vDText35vDText35vDText35n$$If!vh55#v:V 65/ 22 l4 vDText35vDText35vDText35vDText35vDText35vDText35vDText35vDText35n$$If!vh55#v:V 65/ 22 l4 ^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH L@L Z Heading 1$$@&a$5CJ KH$\aJ B"B Z Heading 2$@&5CJ\aJVV Z Heading 3$<@&5CJOJQJ\^JaJDA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List >>> ZTitle$a$5>*CJ\aJ4B4 Z Body Text$a$DZD Z Plain TextCJOJQJ^JaJj#j Z Table Grid7:V0H2H mOV Balloon TextCJOJQJ^JaJB'AB mOVComment ReferenceCJaJ<R< mOV Comment TextCJaJ@jQR@ mOVComment Subject5\PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] " $: V 0 b2>0$Z !!"$$*&&'N((*+B0tr fX^4<4!$&(+-/124579;=@CFHJMORUWY[]^psuvwyz|}~* \ N hdd0 | R!!""#.$<%%^&&d'"(()<+D<vP4 "#%')*,.0368:<>?ABDEGIKLNPQSTVXZ\_qrtx{,>JPr~%1=C^jp ,2;GMWci&6AQcouiu{T`f   0 M Y _ s   * 0 @ P W g    s    % , < J Z a q  V f m } u-FRX  ^jp"(%17BNTbnt *6<JV\my (4:HTZkw} -9? /;A /;A(4:  ,2#)  ! !!!!!!!!!!!!! """FFG$G$FFFFFFFFG$G$FFFFFFFFG$G$FFFFFFFFFFG G FG$G$FG$G$FG$G$FG$G$FFFG$G$G$G$G$G$G$G$G$G$FG$G$G$G$FG$G$FG$G$FG$G$FG$G$G$G$G G G FFG$G$FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF8@0(  B S  ?Text2Text1Check1Check2Check3Check4Check6Check5Check7Check8Check9Check11Check12Text36Text35 " -!)"" QT"3333333->Rq'1F^sWcxM b  3   OqF]#"lIKLN.?:""("b(K9Ib( ' 5!.y+2Z*RmOVRGbZM rk&M\1SL9*1i ;""@ x= "`` ` ````````` `$`&`P@`*`UnknownG* Times New Roman5Symbol3. * ArialG5  hMS Mincho-3 fg?= * Courier New5. *aTahomaA BCambria Math"ha󻦘k ==Y!x24d " " 2QHX ?Z*!xx Anne WarburtonAnne WarburtonOh+'0   @ L X dpx Anne Warburton Normal.dotmAnne Warburton3Microsoft Office Word@F#@hv3@:o3@=՜.+,0 hp  Diving Canada= "  Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~     "Root Entry F0Tlѽ=$Data B1Table-WordDocument4$SummaryInformation(DocumentSummaryInformation8CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q