%PDF-1.5 % 62 0 obj <> endobj xref 62 182 0000000016 00000 n 0000004033 00000 n 0000004925 00000 n 0000004989 00000 n 0000005379 00000 n 0000005708 00000 n 0000005816 00000 n 0000005879 00000 n 0000005967 00000 n 0000006044 00000 n 0000006207 00000 n 0000006237 00000 n 0000006392 00000 n 0000006555 00000 n 0000006585 00000 n 0000006732 00000 n 0000006916 00000 n 0000007138 00000 n 0000007292 00000 n 0000007475 00000 n 0000007697 00000 n 0000007851 00000 n 0000008036 00000 n 0000008258 00000 n 0000008412 00000 n 0000008593 00000 n 0000008623 00000 n 0000008780 00000 n 0000008930 00000 n 0000008960 00000 n 0000009107 00000 n 0000009266 00000 n 0000009296 00000 n 0000009451 00000 n 0000009617 00000 n 0000009647 00000 n 0000009804 00000 n 0000009973 00000 n 0000010004 00000 n 0000010155 00000 n 0000010326 00000 n 0000010474 00000 n 0000010689 00000 n 0000010878 00000 n 0000011100 00000 n 0000011255 00000 n 0000011419 00000 n 0000011451 00000 n 0000011609 00000 n 0000011771 00000 n 0000011803 00000 n 0000011961 00000 n 0000012137 00000 n 0000012169 00000 n 0000012316 00000 n 0000012494 00000 n 0000012526 00000 n 0000012663 00000 n 0000012841 00000 n 0000012873 00000 n 0000013020 00000 n 0000013198 00000 n 0000013230 00000 n 0000013367 00000 n 0000013527 00000 n 0000013559 00000 n 0000013717 00000 n 0000013933 00000 n 0000014088 00000 n 0000014310 00000 n 0000014499 00000 n 0000014654 00000 n 0000014875 00000 n 0000015063 00000 n 0000015278 00000 n 0000015426 00000 n 0000015620 00000 n 0000015775 00000 n 0000015999 00000 n 0000016182 00000 n 0000016337 00000 n 0000016561 00000 n 0000016758 00000 n 0000016982 00000 n 0000017137 00000 n 0000017340 00000 n 0000017562 00000 n 0000017717 00000 n 0000017902 00000 n 0000017934 00000 n 0000018081 00000 n 0000018269 00000 n 0000018451 00000 n 0000018641 00000 n 0000018823 00000 n 0000019011 00000 n 0000019192 00000 n 0000019367 00000 n 0000019399 00000 n 0000019557 00000 n 0000019737 00000 n 0000019769 00000 n 0000019927 00000 n 0000020127 00000 n 0000020159 00000 n 0000020317 00000 n 0000020351 00000 n 0000020384 00000 n 0000020428 00000 n 0000020458 00000 n 0000020480 00000 n 0000020509 00000 n 0000020541 00000 n 0000020574 00000 n 0000020607 00000 n 0000020636 00000 n 0000020666 00000 n 0000020696 00000 n 0000020726 00000 n 0000020759 00000 n 0000020805 00000 n 0000020836 00000 n 0000020881 00000 n 0000020912 00000 n 0000020944 00000 n 0000020976 00000 n 0000021008 00000 n 0000021038 00000 n 0000021068 00000 n 0000021104 00000 n 0000021145 00000 n 0000021206 00000 n 0000021391 00000 n 0000021576 00000 n 0000021761 00000 n 0000021946 00000 n 0000028825 00000 n 0000039668 00000 n 0000039842 00000 n 0000040011 00000 n 0000040142 00000 n 0000040319 00000 n 0000040458 00000 n 0000040640 00000 n 0000040764 00000 n 0000040944 00000 n 0000041126 00000 n 0000041361 00000 n 0000041384 00000 n 0000041621 00000 n 0000042028 00000 n 0000062721 00000 n 0000062749 00000 n 0000063142 00000 n 0000063302 00000 n 0000063372 00000 n 0000063609 00000 n 0000063941 00000 n 0000064196 00000 n 0000064533 00000 n 0000097333 00000 n 0000097361 00000 n 0000097747 00000 n 0000097915 00000 n 0000097985 00000 n 0000098240 00000 n 0000098610 00000 n 0000098869 00000 n 0000099140 00000 n 0000126558 00000 n 0000126586 00000 n 0000126888 00000 n 0000127041 00000 n 0000127111 00000 n 0000127338 00000 n 0000127373 00000 n 0000139772 00000 n 0000140012 00000 n 0000140221 00000 n 0000140475 00000 n 0000004719 00000 n 0000004185 00000 n trailer<<2bb9b27633122a55cb56aeadb0bb6158>] >> startxref 0 %%EOF 63 0 obj <>/AcroForm 64 0 R/Outlines 6 0 R/Metadata 9 0 R>> endobj 243 0 obj<
>stream xRKAXWRH.e'f'(=yZz9HC%Њ4o&Dkv H4҂TO%==]OE/ 1c5X$fàeF=ݨd1! zCFYXvlu/C,i\v5 7d^⦛.~[X~>stream xB 1IX`v+hOC+4ցucTM5\\RW֍nuֺ׃gU][}S_֏~# endstream endobj 64 0 obj <> endobj 65 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/MediaBox[0 0 612 792]/Contents 197 0 R/Group<>/Tabs/S/StructParents 0/Annots 66 0 R/CropBox[ 0 0 612 792]/Rotate 0>> endobj 66 0 obj [ 71 0 R 74 0 R 77 0 R 80 0 R 83 0 R 86 0 R 89 0 R 92 0 R 95 0 R 98 0 R 101 0 R 104 0 R 107 0 R 110 0 R 113 0 R 116 0 R 119 0 R 122 0 R 125 0 R 128 0 R 131 0 R 134 0 R 137 0 R 140 0 R 143 0 R 146 0 R 149 0 R 152 0 R 153 0 R 154 0 R 155 0 R 156 0 R 157 0 R 158 0 R 161 0 R 164 0 R 193 0 R 194 0 R 195 0 R 196 0 R] endobj 67 0 obj <>/Font<>/ProcSet[/PDF/Text]>> endobj 68 0 obj <> endobj 69 0 obj <> endobj 70 0 obj <> endobj 71 0 obj <> endobj 72 0 obj <> endobj 73 0 obj <>stream x endstream endobj 74 0 obj <> endobj 75 0 obj <> endobj 76 0 obj <>stream x endstream endobj 77 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 2 0 R/Rect[ 22.100006103 446.898986816 28.300003051 454.549987792]/Subtype/Widget/Type/Annot>> endobj 78 0 obj <>stream xs 2P t+ȝL333U0354S0327UҏJtIABx4,4Bx\q @ endstream endobj 79 0 obj <>stream x endstream endobj 80 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 2 0 R/Rect[ 58.100006103 446.898986816 64.29901123 454.549987792]/Subtype/Widget/Type/Annot>> endobj 81 0 obj <>stream xs 2P t+ȝL333U0354S0327UҏJtIABx4,4Bx\q @ endstream endobj 82 0 obj <>stream x endstream endobj 83 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 2 0 R/Rect[ 94.098999023 446.898986816 100.29901123 454.549987792]/Subtype/Widget/Type/Annot>> endobj 84 0 obj <>stream xs 2P t+ȝL633U0354S0327UҏJtI --Bx4,4Bx\q t^ endstream endobj 85 0 obj <>stream x endstream endobj 86 0 obj <> endobj 87 0 obj <> endobj 88 0 obj <>stream x endstream endobj 89 0 obj <> endobj 90 0 obj <> endobj 91 0 obj <>stream x endstream endobj 92 0 obj <> endobj 93 0 obj <> endobj 94 0 obj <>stream x endstream endobj 95 0 obj <> endobj 96 0 obj <> endobj 97 0 obj <>stream x endstream endobj 98 0 obj <> endobj 99 0 obj <> endobj 100 0 obj <>stream x endstream endobj 101 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 3 0 R/Rect[ 66 386.148986816 72.25 393.850006103]/Subtype/Widget/Type/Annot>> endobj 102 0 obj <>stream x endstream endobj 103 0 obj <>stream xs 2P t+ȝL13W035R030VҏJtI --Bx4,4Bx\fq em) endstream endobj 104 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 3 0 R/Rect[ 130.098999023 386.148986816 136.300003051 393.850006103]/Subtype/Widget/Type/Annot>> endobj 105 0 obj <>stream xs 2P t+ȝL63W0354S030VҏJtI --Bx4,4Bx\fq d) endstream endobj 106 0 obj <>stream x endstream endobj 107 0 obj <> endobj 108 0 obj <> endobj 109 0 obj <>stream x endstream endobj 110 0 obj <> endobj 111 0 obj <> endobj 112 0 obj <>stream x endstream endobj 113 0 obj <> endobj 114 0 obj <> endobj 115 0 obj <>stream x endstream endobj 116 0 obj <> endobj 117 0 obj <> endobj 118 0 obj <>stream x endstream endobj 119 0 obj <> endobj 120 0 obj <> endobj 121 0 obj <>stream x endstream endobj 122 0 obj <> endobj 123 0 obj <> endobj 124 0 obj <>stream x endstream endobj 125 0 obj <> endobj 126 0 obj <> endobj 127 0 obj <>stream x endstream endobj 128 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Rect[ 166.098999023 249.350006103 172.300003051 257.04901123]/Subtype/Widget/T(Check_made_payable_to_ITEC)/Type/Annot/TU 181 0 R>> endobj 129 0 obj <>stream x endstream endobj 130 0 obj <>stream xs 2P t+ȝL63T0354S030VҏJtI r!i\ !Y\@Ӹ 2 endstream endobj 131 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 4 0 R/Rect[ 469.699005126 249.350006103 475.898986816 257.04901123]/Subtype/Widget/Type/Annot>> endobj 132 0 obj <>stream x endstream endobj 133 0 obj <>stream xs 2P t+ȝL33L ,Bry]|4^. M,^.Wy\ endstream endobj 134 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 4 0 R/Rect[ 518.648986816 249.350006103 524.898986816 257.04901123]/Subtype/Widget/Type/Annot>> endobj 135 0 obj <>stream xs 2P t+ȝL13T035R030VҏJtI R!i\ !Y\@Ӹ endstream endobj 136 0 obj <>stream x endstream endobj 137 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Rect[ 166.098999023 234.5 172.300003051 242.149002075]/Subtype/Widget/T(Credit_Card)/Type/Annot/TU 182 0 R>> endobj 138 0 obj <>stream x endstream endobj 139 0 obj <>stream xs 2P t+ȝL633T0354S0327QҏJtI --Bx4,4Bx\q A endstream endobj 140 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 5 0 R/Rect[ 166.098999023 217.699996948 173.5 226.548995971]/Subtype/Widget/Type/Annot>> endobj 141 0 obj <>stream x endstream endobj 142 0 obj <>stream xs 2P t+ȝ\̶г0T0334S0317QҏJtI --Bx4,4Bx\q endstream endobj 143 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 5 0 R/Rect[ 213.348999023 217.699996948 220.800003051 226.548995971]/Subtype/Widget/Type/Annot>> endobj 144 0 obj <>stream xs 2P t+ȝ\̱г0T033R0317QҏJtI --Bx4,4Bx\q c endstream endobj 145 0 obj <>stream x endstream endobj 146 0 obj <>>>/AS/Off/F 4/FT/Btn/H/T/P null/Parent 5 0 R/Rect[ 300.699005126 217.699996948 308.148986816 226.548995971]/Subtype/Widget/Type/Annot>> endobj 147 0 obj <>stream xs 2P t+ȝ\̳г ̌LMBry]|CKK4^. M,^.Wq\ endstream endobj 148 0 obj <>stream x endstream endobj 149 0 obj <> endobj 150 0 obj <> endobj 151 0 obj <>stream x endstream endobj 152 0 obj <>/F 4/FT/Tx/Ff 29360128/P null/Rect[ 85.900009155 174.949996948 141.098999023 188.649002075]/Subtype/Widget/T(Card_Number)/Type/Annot/TU 184 0 R/MaxLen 4>> endobj 153 0 obj <>/F 4/FT/Tx/Ff 29360128/P null/Rect[ 149.5 174.949996948 204.699005126 188.649002075]/Subtype/Widget/T(Card_Number0)/Type/Annot/TU 185 0 R/MaxLen 4>> endobj 154 0 obj <>/F 4/FT/Tx/Ff 29360128/P null/Rect[ 213.098999023 174.949996948 268.100006103 188.649002075]/Subtype/Widget/T(Card_Number1)/Type/Annot/TU 186 0 R/MaxLen 4>> endobj 155 0 obj <>/F 4/FT/Tx/Ff 29360128/P null/Rect[ 276.5 174.949996948 331.699005126 188.649002075]/Subtype/Widget/T(Card_Number2)/Type/Annot/TU 187 0 R/MaxLen 4>> endobj 156 0 obj <>/F 4/FT/Tx/Ff 29360128/P null/Rect[ 483.106140136 174.424407958 508.688110351 188.199325561]/Subtype/Widget/T(Textfield3)/Type/Annot/TU 188 0 R/MaxLen 2>> endobj 157 0 obj <>/F 4/FT/Tx/Ff 29360128/P null/Rect[ 511.699005126 174.25 561.849975585 187.899002075]/Subtype/Widget/T(Textfield4)/Type/Annot/TU 189 0 R/MaxLen 4>> endobj 158 0 obj <> endobj 159 0 obj <> endobj 160 0 obj <>stream x endstream endobj 161 0 obj <> endobj 162 0 obj <> endobj 163 0 obj <>stream x endstream endobj 164 0 obj <> endobj 165 0 obj <> endobj 166 0 obj <>stream x endstream endobj 167 0 obj (Resident_State) endobj 168 0 obj (Insurance_Lic) endobj 169 0 obj (Preferred_Name_for_Badge) endobj 170 0 obj (First_Name) endobj 171 0 obj (MI) endobj 172 0 obj (Last_Name) endobj 173 0 obj (Designations) endobj 174 0 obj (Date_of_Birth) endobj 175 0 obj (AgencyCompany) endobj 176 0 obj (Textfield) endobj 177 0 obj (Textfield0) endobj 178 0 obj (Textfield1) endobj 179 0 obj (Textfield2) endobj 180 0 obj (EMail_Address) endobj 181 0 obj (Check_made_payable_to_ITEC) endobj 182 0 obj (Credit_Card) endobj 183 0 obj (Credit_Card_Security_Code) endobj 184 0 obj (Card_Number) endobj 185 0 obj (Card_Number0) endobj 186 0 obj (Card_Number1) endobj 187 0 obj (Card_Number2) endobj 188 0 obj (Textfield3) endobj 189 0 obj (Textfield4) endobj 190 0 obj (Cardholders_Name) endobj 191 0 obj (Cardholders_Signature) endobj 192 0 obj (Credit_card_billing_address_with_zip_code) endobj 193 0 obj <>>> endobj 194 0 obj <>>> endobj 195 0 obj <>>> endobj 196 0 obj <>>> endobj 197 0 obj <>stream x]msȑ*.Ȕa^i9QʖrwT(m? T_zzzfyzζwm