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Get UCSC Volunteer Waiver and Election of Workers' Compensation Coverage 2015

Lease print or type) NAME OF VOLUNTEER: _______________________________________________________________________________________________ DATE OF BIRTH: ____________________________ SEX: M F HOME PHONE: ( ) ___________________________________ HOME ADDRESS: _____________________________________________________________________________________________________ UCSC SPONSORED PROGRAM/EVENT/ACTIVITY IN WHICH SERVICE WILL BE PROVIDED: __________________________________ UCSC DEPARTMENT FOR WHICH VOLU.

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