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PLEASE RETURN THIS COMPLETED WAIVER FORM & PAYMENT BY FRIDAY, NOVEMBER 4, 2016, TO: EYE, PO Box 31638, San Francisco, CA 941310638
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The completed waiver form and payment must be returned.
All individuals or entities are required to file the completed waiver form with payment.
The form must be completed with all required information and the payment must be included.
The purpose is to obtain a waiver for a specific purpose.
All relevant information must be reported on the form.
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