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Photo & Information Authorization Requirement

Authorization(Required)
Electronic Signature(Required)
I agree to complete the Authorization by electronic means. I agree that the laws of the Commonwealth of Pennsylvania will apply concerning the Authorization.
Photo & Information Authorization(Required)
I HAVE READ AND UNDERSTAND THE ABOVE PHOTO AND INFORMATION AUTHORIZATION. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE. IF I AM UNDER 18 YEARS OF AGE, MY PARENT/GUARDIAN HAS READ AND UNDERSTAND THE ABOVE PHOTO AND INFORMATION AUTHORIZATION
Please type your full name to indicate that you have read and understand the Authorization
MM slash DD slash YYYY
Name of Minor Child (if applicable)
MM slash DD slash YYYY
Name of Parent/Guardian
This field is for validation purposes and should be left unchanged.

Here for our community, for always.

Main Office

COMMUNITY FOUNDATION
FOR THE ALLEGHENIES

216 Franklin Street, Suite 400
Johnstown, PA 15901

(814) 536-7741
info@cfalleghenies.org

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