ENROLLMENT SUBMISSION CONFIRMATION

Contractor Information

Contractor's Legal Name:

#form.Contractor#

Submitter's E-mail Address:

#form.email_from#

Submitter's Title:

#form.PreparerTitle#

Submitter's Phone Number:

#form.PreparerPhone#

I verify receipt of the iCip Manual for this project, located on the iCip Toolkit home page.

I recognize that this Manual is part of the administration of the iCip and it is our responsibility to distribute the Manual to personnel involved in this project.

#form.ReceiptConfirm#

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