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Would you grant permission Yes No SIGNATURE DATE Thank you for your interest in volunteering for the State Long-Term Care Ombudsman Program. Please send this form to the Volunteer Developer and she will forward it to the appropriate program. Phyllis Meyerson Volunteer Developer 13412 Green Hills Ct Highland MD 20777 OR call Ombudsman Program at the Maryland Dept. STATE LONG TERM CARE OMBUDSMAN PROGRAM SLTCOP Volunteer Application Name Email Address Home Phone Work Phone...
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