ÐÏࡱá>þÿ ‹�þÿÿÿ‰Šÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á7 ø¿ÖYbjbjQ÷Q÷ 1‚3�Îd3�ÎdËðÿÿÿÿÿÿ·& & kkkkkÿÿÿÿ8·l# ˆ;t/P•••p |¤ T§:©:©:©:©:©:©:$ü<¶²?°Í:uk#pp##Í:kk••ÛB;o&o&o&#^k•k•§:o&#§:o&o&ú¯7ÀS:•ÿÿÿÿÀ�wÅã0Ôÿÿÿÿc#jo9*“:X;0ˆ;™9ºb@Í#Jb@TS:b@kS:@t’ ho&n T CtttÍ:Í:&Xtttˆ;####ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb@ttttttttt& 1: training, experience and preceptor ATTESTATION - G (Authorized Medical Physicist) The Wisconsin Department of Health Services is requesting disclosure of all information on this statement for the purpose of authorizing an individual to work with radioactive material. Failure to provide any information may result in denial or delay of authorizing an individual to work with radioactive material. For Authorized Medical Physicist.Instructions: Complete all applicable items. Refer to WISREG-1556, Volume 9, “Guidance for Medical Use of Radioactive Material.” Use supplementary sheets where necessary. Retain one copy and submit original of the document to the State of Wisconsin, Department of Health Services, P.O. Box 2659, Madison, WI 53701-2659.PART I TRAINING AND EXPERIENCEDescribe training and experience in sufficient detail to match the training and experience criteria in applicable regulations. Name of Individual  FORMTEXT      Authorization requested (e.g., Sr-90 ophthalmic use, gamma knife, HDR):  FORMTEXT      Certification (attach copy of current certificate)Specialty BoardCategoryMonth and Year Certified  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      Note: Items 4-6 do not need to be completed when using Board Certification to meet Wis. Admin. Code DHS 157 Subchapter VI training and experience requirements.Formal Training Degree and Area of StudyName and Location of Program with Corresponding Materials License NumberDates FORMTEXT        FORMTEXT       FORMTEXT        FORMTEXT        FORMTEXT      ,  FORMTEXT     FORMTEXT      - FORMTEXT      FORMTEXT      5. Supervised Work ExperienceDescription of ExperienceDates of Experience Description of ExperienceDates of ExperiencePerforming sealed source leak tests and inventories FORMTEXT      Hands-on device operation FORMTEXT      Performing decay corrections FORMTEXT      Safety procedures FORMTEXT      Performing full calibration and periodic spot checks FORMTEXT      Clinical use FORMTEXT      Conducting radiation surveys FORMTEXT      Operation of a treatment planning system FORMTEXT       Supervising Individual  Identification and QualificationsIf more than one supervising individual is needed to meet requirements in Wisconsin Administrative Code, DHS 157 Subchapter VI, provide the following information for each: FORMCHECKBOX  Supervisor meets the requirements of s. DHS 157.61(8) or (10) or equivalent NRC or another Agreement State requirements for the type(s) of use for which the person named in Item 1 is seeking authorization. Name of Supervising Individual  FORMTEXT 3QRS³ À ø þ ÿ    ˜ ™ š ¬ ® ¯ ¹ º óèóáÔɼ±£±£š�Œ�~sg_Mg;"jh}2“CJUaJmHnHu#�jïh4C±h}2“CJUaJh}2“CJaJjh}2“CJUaJh}2“5�CJOJQJhžb%h}2“5�CJOJQJh}2“h}2“CJOJQJh}2“5�OJQJhj 6h}2“5�OJQJ^Jh}2“5�OJQJ^Jh}2“5�6�CJOJQJh}2“6�CJOJQJh}2“5�6�CJOJQJ h}2“5�CJh}2“6�CJOJQJh}2“6�;�CJOJQJ3RST² ××uJJ+$$$d%d&d'dIfNÆÿOÆÿPÆÿQÆÿa$akd$$If–l4ÖÖ¦ÿò+L,ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laöf4($$d%d&d'dIfNÆÿOÆÿPÆÿQÆÿ² ³ ÷ žs+$$$d%d&d'dIfNÆÿOÆÿPÆÿQÆÿa$`kd�$$If–lÖ”Ö¦ÿò+€L,ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laö÷ ø   ˜ ž˜6˜akd¯$$If–l4ÖÖ¦ÿò+L, ÿÿÿÿ ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÖÿÿÿÿ4Ö laöf4$If`kd$$If–lÖ”Ö¦ÿò+€L,ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laö˜ ™ ­ ®  ž   È ›‘‹‹‘�� Æo$If$If & F$IfckdJ$$If–l4Ö”MÖ¦ÿò+€L,ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÖÿÖÿÿÿÿ4Ö laöf4  < š œ   ¢ ¶ ¸ º Ä Æ È Ê 0 2 – ˜ š œ ° ² ´ óèÚÏÁÏó¹§ó•óè‘‹‘Ï‹{laOl#�jh1T h}2“CJUaJh1T h}2“CJaJjh1T h}2“CJUaJh1T h}2“5�CJOJQJaJ h}2“CJh}2“"jh}2“CJUaJmHnHu#�jch4C±h}2“CJUaJh}2“CJaJhžb%h}2“5�CJOJQJh}2“5�CJOJQJh„kh}2“5�CJOJQJh4C±h}2“CJaJjh}2“CJUaJÈ Ê 0 2 ˆ~akd $$If–l4ÖÖ¦ÿò+L,ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laöf4  & F$Ifvkd×$$If–l4Ö”*Ö0¦ÿò+xÿÿÿÿÿÿÿÿÔÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÖÿÿÿÿÿÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿ4Ö laöf42 R d – ˜ š Â Ä ì î Fööönöööööö‡kd-$$If–l4ÖÖF¦ÿîâò+Hÿÿÿÿÿÿÿÿô ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖ ÿÿÿÖ ÿÿÿÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿ4Ö laöf4 $$Ifa$ ´ ¾ À Â Ä Æ Ú Ü Þ è ê ì î ð  468BDFHëÜÑÁÜѯܖÜÑÁÜфܖÜ{ÜÑiÜ–Ü{eT hVt h}2“CJOJQJ^JaJh}2“#�jxh1T h}2“CJUaJh}2“5�OJQJ#�jh1T h}2“CJUaJ0jh1T h}2“CJOJQJUaJmHnHu#�j�h1T h}2“CJUaJh1T h}2“5�CJOJQJaJh1T h}2“CJaJjh1T h}2“CJUaJ(jh1T h}2“CJUaJmHnHuFHˆuo$If‰kdì$$If–l4Ö”ÂÖF¦ÿîâò+Hÿÿÿÿô ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖ ÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÖ ÿÿÿÿÿÿ4Ö laöf4ˆŠ€‚–˜š¤¦¨ª¬ÀÂÄÎÐÒÔèêìöøúüòáÝÒÆ¾¬ÆšÆ¾�ƾ}ÆšÆrƾ`ƚƾƾNÆ#�j8 h1T h}2“CJUaJ#�jÄ h4C±h}2“CJUaJh4C±h}2“CJaJ#�jP h4C±h}2“CJUaJh4C±h}2“CJ aJ "jh}2“CJUaJmHnHu#�jÜ h4C±h}2“CJUaJh}2“CJaJjh}2“CJUaJh}2“5�CJOJQJh}2“ hVt h}2“CJOJQJ^JaJhõG¤CJOJQJ^JaJˆŠ¬®à›�-$ $$Ifa$akdb $$If–l4ÖÖ¦ÿò+L,ÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÖÿÿÿÿ4Ö laöf4 & F¤x$IfckdÃ$$If–l4Ö”1Ö¦ÿò+L,ÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÖÿÿÿÿ4Ö laöf4àr~€¨ªÒú"¾æôôlcôcôôôô $$Ifa$‡kdý $$If–l4ÖÖF¦ÿ:À!ò+€”ÿÿÿÿ†ÿÿÿÿ€2 ÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖ ÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÖ ÿÿÿÿÿÿ4Ö laöf4 $¤x$Ifa$  "$8:<FHLNbdfjlpr†ˆŠ”–˜š®°²º¼¾ÀÔÖØâäæè&îâÚâÚÈâîâÚâÚ¶âîâÚâÚ¤âîâÚâÚ’âîâ‡âÚuâîâ‡jfh}2“h}2“5�CJOJQJ#�j~h4C±h}2“CJUaJh4C±h}2“CJaJ#�jh1T h}2“CJUaJ#�j” h1T h}2“CJUaJ#�j h1T h}2“CJUaJ#�j¬ h1T h}2“CJUaJh}2“CJaJjh}2“CJUaJ"jh}2“CJUaJmHnHu(æè&ul $$Ifa$‰kdô$$If–l4Ö”€ÖF¦ÿ:À!ò+€”ÿÿÿÿÿÿÿÿ†ÿÿÿÿÿÿÿÿ€2 ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖ ÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿ4Ö laöf4&(\†ºâ›’’’’ $$Ifa$ckdå$$If–l4Ö”Ö¦ÿò+L,ÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÖÿÿÿÿ4Ö laöf4&(âäLNbdfprt¨ª¾ÀÂÌÎÐÒ "$&024XZnpr|~€‚ìîúïëïß×Å߳ߨïß×–ß³ßïëïßׄ߳ߨïß×rß³ßïëïß×#�j.h4C±h}2“CJUaJ#�j¸h4C±h}2“CJUaJ#�jh4C±h}2“CJUaJh4C±h}2“CJaJ"jh}2“CJUaJmHnHu#�j¨h4C±h}2“CJUaJh}2“CJaJjh}2“CJUaJh}2“h}2“5�CJOJQJ h}2“5�(âäLt¨ÐMBBBB $¤x$Ifa$²kd„$$If–l4Ö”‚Ö\¦ÿš €À!ò+€ô ÿÿÿÿ€æ ÿÿÿÿ€@ €2 ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÿÿÿÿÿÿÖÿÿÿÿÖÿÿÿÿÿÿÿ4Ö laöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÐÒ 4X€MBBBB $¤x$Ifa$²kd”$$If–l4Ö” Ö\¦ÿš €À!ò+€ô ÿÿÿÿ€æ ÿÿÿÿ€@ €2 ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÿÿÿÿÿÿÖÿÿÿÿÖÿÿÿÿÿÿÿ4Ö laöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ€‚ì.VMBBBB $¤x$Ifa$²kd¤$$If–l4Ö” Ö\¦ÿš €À!ò+€ô ÿÿÿÿ€æ ÿÿÿÿ€@ €2 ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÿÿÿÿÿÿÖÿÿÿÿÖÿÿÿÿÿÿÿ4Ö laöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ.0DFHRTVX’”¨ª¬¶¸º "$&024:°²„ŠíáÏáĹᱟáÏá¹›¹á±‰áÏáĹá±wáÏá¹›¹r›n›rhõG¤ h}2“5�#�jNh4C±h}2“CJUaJ#�jØh4C±h}2“CJUaJh}2“#�j>h4C±h}2“CJUaJh}2“CJaJh}2“5�CJOJQJh4C±h}2“CJaJ"jh}2“CJUaJmHnHujh}2“CJUaJ#�jÈh4C±h}2“CJUaJ%VX’º 4MBBBB $¤x$Ifa$²kd´$$If–l4Ö” Ö\¦ÿš €À!ò+€ô ÿÿÿÿ€æ ÿÿÿÿ€@ €2 ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÿÿÿÿÿÿÖÿÿÿÿÖÿÿÿÿÿÿÿ4Ö laöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ46:°MK? & F¤x$If²kdÄ$$If–l4Ö” Ö\¦ÿš €À!ò+€ô ÿÿÿÿ€æ ÿÿÿÿ€@ €2 ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÿÿÿÿÿÿÖÿÿÿÿÖÿÿÿÿÿÿÿ4Ö laöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ°²›•1& $¤x$Ifa$ckd�$$If–l4Ö”ëÖ¦ÿò+€L,ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laöf4$Ifckdè$$If–l4Ö” Ö¦ÿò+€L,ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laöf4ADèé  N N NNNŽN�NðåÏðåÅ»Å峨–‰q–oX–HD³¨h}2“hž h}2“5�CJOJQJaJ-jh}2“5�CJOJQJUaJmHnHuU.�jDhž h}2“5�CJOJQJUaJh}2“5�CJOJQJaJ"jh}2“5�CJOJQJUaJhž h}2“CJ aJ hboh}2“5�hõG¤CJOJQJh}2“CJOJQJ*�j$hž h}2“5�CJOJQJUh}2“5�CJOJQJjh}2“5�CJOJQJUèé NN÷zrlrl$If¤<$If}kd˜$$If–l4Ö”…Ö0¦ÿ’ò+ìÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ`'ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿ4Ö laöf4pÖ ÿÿ¤x$If      Name of License on which Supervising Individual is Authorized  FORMTEXT       Materials License Number (Indicate which state or if NRC)  FORMTEXT      PART II PRECEPTOR ATTESTATIONNOTE: This part must be completed by the individual s preceptor. If more than one preceptor is necessary to document experience, obtain a separate preceptor statement from each. 7. Preceptor Approval and Attestation  FORMCHECKBOX  I am an authorized medical physicist authorized for the type(s) of use for which the individual named in Item 1 is seeking authorized medical physicist status.I attest that the individual named in Item 1: FORMCHECKBOX Has satisfactorily completed the training requirements in s. DHS 157.61(8).  AND FORMCHECKBOX Has achieved a level of competency sufficient to independently function as an authorized medical physicist for each type of therapeutic medical unit for which the individual is requesting authorized medical physicist status. Name of License on which Preceptor is Authorized  FORMTEXT       Materials License Number (Indicate which state or if NRC)  FORMTEXT       Print Name of Preceptor  FORMTEXT       SIGNATURE  Preceptor Date Signed  FORMTEXT           F-45010G (Rev 07/08)Page  PAGE 2 DEPARTMENT OF HEALTH SERVICESSTATE OF WISCONSINDivision of Public HealthBureau of Environmental HealthF-45010G (Rev. 07/08)Radiation Protection Section(608) 267-4797 NNŽN�N¸NºN.O0OXO›“‹‹‹“……$If¤$If¤<$Ifckdº$$If–l4Ö”iÖ¦ÿò+L,ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laöf4�N’N¦N¨NªN´N¶N¸NºN,O.O0O2OFOHOJOTOVOXOZO˜OšOïãÍï·ï¨¤œ—Œ€xf€T€I—?¤hú2*h}2“5�CJhž h}2“CJaJ"jh}2“CJUaJmHnHu#�jÏhž h}2“CJUaJh}2“CJaJjh}2“CJUaJhž h}2“CJ aJ h}2“5�hboh}2“5�h}2“hž h}2“CJOJQJaJ*jh}2“CJOJQJUaJmHnHu+�jYhž h}2“CJOJQJUaJh}2“CJOJQJaJjh}2“CJOJQJUaJXOZO˜OšO}uo$If¤$If‚kdE$$If–l4Ö” Ö0¦ÿÌò+&ÿÿÿÿ&ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÖÿÿÿÿÿÖÿÿÖÿÿÿÿÿ4Ö laöf4pÖÿÿÿÿÿÿÿÿÿÿÿÿšOœOQ Qˆ€ckdÊ$$If–l4Ö”lÖ¦ÿò+€L, ÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÖÿÿÿÿ4Ö laöf4¤$Ifvkd$$If–l4Ö”KÖ0¦ÿ<ò+€– ÿÿÿÿ ÿÿÿÿ¶ ÿÿÿÿ ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÖÿÿÿÿÿÿÿÿÖÿÿÖÿÿÿÿÿÿÿÿ4Ö laöf4šOœOªOQXQZQ\QxQzQ|Q¸QÊQèQvRˆR˜RÎRÐRÒRÔR0S2S4SPSRSTSVSÐSÖSðSôSTTT$TôðéðäÚäÊÚä¶ÂäÂäÂäð¥ô•ô•ôukuôuô•ôhõG¤CJOJQJh}2“CJOJQJ*�j<"hž h}2“5�CJOJQJUjh}2“5�CJOJQJU hö%Ñh}2“CJOJQJ^JaJhõ&›h}2“5�^JaJhõ&›h}2“5��j} hž h}2“5�Ujh}2“5�U h}2“5� hú2*h}2“h}2“h}2“5�CJOJQJ" QZQÒRÔR0Sùçƒs„°„>þ¤x$If^„°`„>þckdñ $$If–l4Ö” Ö¦ÿò+L,ÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÖÿÿÿÿ4Ö laöf4 ÆÌ„„˜þ$If^„`„˜þ$If0S2SVSðS•Šz„°„>þ¤x$If^„°`„>þ $¤x$Ifa$jkd�!$$If–l4Ö”…Ö¦ÿò+L,ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laöf4pÖ ÿÿðSòSôST‚wg„°„>þ¤x$If^„°`„>þ $¤x$Ifa$}kd¤"$$If–l4Ö”…Ö0¦ÿ’ò+€ìÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ€`'ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿ4Ö laöf4pÖ ÿÿTT*TìUîU‚woo¤x$If $¤x$Ifa$}kdV#$$If–l4Ö”…Ö0¦ÿ’ò+ìÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ`'ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿ4Ö laöf4pÖ ÿÿ$T&T(T*TìUîUðUTVVVXVlVnVpVzV|V€VôVöV W WWWWWêÚÏŶϮž’Šx’f’bZ’ŠH’f’=hž h}2“CJaJ#�jŽ%hž h}2“CJUaJh—o(h}2“5�h}2“"jh}2“CJUaJmHnHu#�j$%hž h}2“CJUaJh}2“CJaJjh}2“CJUaJhž h}2“5�CJ OJQJaJ hí,h}2“5�h! ˆh}2“CJOJQJaJh}2“CJOJQJh}2“5�CJOJQJjh}2“5�CJOJQJU*�j$hž h}2“5�CJOJQJUîUðUTVVV~V€VôVWW‚zzttztz$If¤<$If}kdj$$$If–l4Ö”…Ö0¦ÿ’ò+ìÿÿÿÿÿÿÿÿÿÿÿÿ`'ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÿÿÿÿÿÿÖÿÿÿÿÿÿÿÿÖÿÿÖÿÿÿÿÿÿÿÿ4Ö laöf4pÖ ÿÿWWPWRWTWhWjWlWvWxWzW~WªW®WÆWÈWÊWÞWàWâWìWîWðWòWôWöWü÷ìÚ͵ڞڎü÷ü÷ì‚zh‚V‚K÷üCjhb°Uhž h}2“CJaJ"jh}2“CJUaJmHnHu#�jâ'hž h}2“CJUaJh}2“CJaJjh}2“CJUaJhž h}2“5�CJOJQJaJ-jh}2“5�CJOJQJUaJmHnHu.�jÍ&hž h}2“5�CJOJQJUaJh}2“5�CJOJQJaJ"jh}2“5�CJOJQJUaJhž h}2“CJ aJ h}2“5�h}2“W WPWRWzW|Wˆ€z€z$If¤<$Ifvkd&$$If–l4Ö”iÖ0¦ÿ ò+zÿÿÿÿÿÿÿÿÒÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÖÿÿÿÿÿÖÿÿÿÿÿÖÿÿÿÿÿ4Ö laöf4|W~WªW¬W®WÆWÈWðW›“��“��$If¤<$IfckdC'$$If–l4Ö”iÖ¦ÿò+L,ÿÿÿÿÿÿÿÿÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÖÿÿÿÿÖÿÿÿÿÖÿÿÿÿ4Ö laöf4ðWòWôWøWúWþWXXX X XXX:Xˆ†††††††††„„~$IfvkdX($$If–l4Ö”iÖ0¦ÿþò+X ÿÿÿÿÿÿÿÿô ÿÿÿÿÖ0ÿÿÿÿÿÿöL,ööÖÿÿÖÿÿÿÿÿÖÿÿÖÿÿÿÿÿÿÿÿ4Ö laöf4 öWúWüWXXXX XX:XDXFXRXTXVXXXbXdXfXlXÎYÐYÒYÔYÖYüôüôüôüãÒ¾¥¾¥‹¥Òã‡yhW‡üSh}2“ h'zqhð5HCJOJQJ^JaJ h ^ûhð5HCJOJQJ^JaJhð5HCJOJQJ^JaJhð5H2h ^ûh Ù0JCJOJQJ^JaJhmHnHu0jh ^ûhð5H0JCJOJQJU^JaJh'h ^ûhð5H0JCJOJQJ^JaJh h ^ûhð5HCJOJQJ^JaJ h'zqhð5HCJOJQJ^JaJjhb°Uhb°:XZX\X^X`XbXó“��-_kdŽ)$$If–lÖ0”ÿÐ,ìì tàö6öÖÿÿÖÿÿÖÿÿÖÿÿ4Ö4Ö laöpÖÿÿÿÿyt ^û$If_kd/)$$If–lÖ0”ÿÐ,ìì tàö6öÖÿÿÖÿÿÖÿÿÖÿÿ4Ö4Ö laöpÖÿÿÿÿyt ^û $$Ifa$gd ^ûbXdXfXhXjXlX¨XÎXÐXYBYýûýýýõé‡õéakdí)$$If–l”¿Ö0”ÿÎ,ìì tàö6öÖÿÿÖÿÿÖÿÿÖÿÿ4Ö4Ö laöpÖÿÿÿÿyt ^û $$Ifa$gd ^û$If BYDYpYªY¬Y�—‹)akd³*$$If–l”½Ö0”ÿÎ,ìì tàö6öÖÿÿÖÿÿÖÿÿÖÿÿ4Ö4Ö laöpÖÿÿÿÿyt ^û $$Ifa$gd ^û$IfakdP*$$If–l”½Ö0”ÿÎ,ìì tàö6öÖÿÿÖÿÿÖÿÿÖÿÿ4Ö4Ö laöpÖÿÿÿÿyt ^û¬Y®YÌYÎYÐYÒYÔYÖYù틉‡‡‡akd+$$If–l”½Ö0”ÿÎ,ìì tàö6öÖÿÿÖÿÿÖÿÿÖÿÿ4Ö4Ö laöpÖÿÿÿÿyt ^û $$Ifa$gd ^û$If/ 0&P°Ð/ °à=!°Ð"°h#�8$�h%°°° �Ћ$$If–!vh#vL,:V –l4Ö0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿÿÿÿÿÿÿÿ4Öaöf4�$$If–!vh#vL,:V –l”Ö0ÿÿÿÿÿÿöL,ö,Ö5ÖL,/Ö ÿÿÿÿÿÿÿÿ4Öaö�$$If–!vh#vL,:V –l”Ö0ÿÿÿÿÿÿöL,ö,Ö5ÖL,/Ö ÿÿÿÿÿÿÿÿ4Öaö™$$If–!vh#vL,:V –l4Ö0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿ /Ö  ÿÿÿÿÿÿÿÿ4Öaöf4£$$If–!vh#vL,:V –l4”MÖ0ÿÿÿÿÿÿöL,ö,Ö5ÖL,/Ö  ÿÿÿÿÿÿÿÿ/Ö ÿ4Öaöf4tDÿÿÿÿ‘Text1tDÿÿÿÿAText2Ç$$If–!vh#vx#vÔ:V –l4”*Ö0ÿÿÿÿÿÿöL,ö5Öx5ÖÔ/Ö  ÿ/Ö ÿÿÿÿÿÿÿÿ/Ö ÿ/Ö  ÿÿÿÿÿÿÿÿ4Öaöf4‹$$If–!vh#vL,:V –l4Ö0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿÿÿÿÿÿÿÿ4Öaöf4í$$If–!vh#vH#vô #v:V –l4Ö0ÿÿÿÿÿÿöL,ö5ÖH5Öô 5Ö/Ö ÿÿÿÿÿÿÿÿ/Ö  ÿ/Ö ÿ/Ö ÿ/Ö  ÿÿÿÿÿÿÿÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4tDÿÿÿÿUText2tDÿÿÿÿUText3tDÿÿÿÿText4tDÿÿÿÿText5Õ$$If–!vh#vH#vô #v:V –l4”ÂÖ0ÿÿÿÿÿÿöL,ö5ÖH5Öô 5Ö/Ö  ÿ/Ö  ÿÿÿÿÿÿÿÿ/Ö ÿÿÿÿÿÿÿÿ/Ö ÿ4Öaöf4�$$If–!vh#vL,:V –l4”1Ö0ÿÿÿÿÿÿöL,ö5ÖL,/Ö  ÿÿÿÿÿÿÿÿ/Ö ÿ4Öaöf4™$$If–!vh#vL,:V –l4Ö0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿ/Ö  ÿÿÿÿÿÿÿÿ4Öaöf4Ý$$If–!vh#v”#v†#v2 :V –l4Ö0ÿÿÿÿÿÿöL,ö,Ö,Ö5Ö”5Ö†5Ö2 /Ö  ÿ/Ö ÿ/Ö  ÿÿÿÿÿÿÿÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4tDÿÿÿÿText6tDÿÿÿÿAText7tDÿÿÿÿAText8tDÿÿÿÿAText6tDÿÿÿÿText7tDÿÿÿÿText8tDÿÿÿÿText9vDÿÿÿÿText10vDÿÿÿÿText11ï$$If–!vh#v”#v†#v2 :V –l4”€Ö0ÿÿÿÿÿÿöL,ö,Ö,Ö5Ö”5Ö†5Ö2 /Ö  ÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ/Ö ÿÿÿÿÿÿÿÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4�$$If–!vh#vL,:V –l4”Ö0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿ/Ö  ÿÿÿÿÿÿÿÿ4Öaöf4"$$If–!vh#vô #væ #v@ #v2 :V –l4”‚Ö0ÿÿÿÿÿÿöL,ö,Ö5Öô 5Öæ 5Ö@ 5Ö2 /Ö ÿÿÿÿÿÿÿÿ/Ö  ÿ/Ö ÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿvDÿÿÿÿText12vDÿÿÿÿText12"$$If–!vh#vô #væ #v@ #v2 :V –l4” Ö0ÿÿÿÿÿÿöL,ö,Ö5Öô 5Öæ 5Ö@ 5Ö2 /Ö ÿÿÿÿÿÿÿÿ/Ö  ÿ/Ö ÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿvDÿÿÿÿText12vDÿÿÿÿText12"$$If–!vh#vô #væ #v@ #v2 :V –l4” Ö0ÿÿÿÿÿÿöL,ö,Ö5Öô 5Öæ 5Ö@ 5Ö2 /Ö ÿÿÿÿÿÿÿÿ/Ö  ÿ/Ö ÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿvDÿÿÿÿText12vDÿÿÿÿText12"$$If–!vh#vô #væ #v@ #v2 :V –l4” Ö0ÿÿÿÿÿÿöL,ö,Ö5Öô 5Öæ 5Ö@ 5Ö2 /Ö ÿÿÿÿÿÿÿÿ/Ö  ÿ/Ö ÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿvDÿÿÿÿText12vDÿÿÿÿText12"$$If–!vh#vô #væ #v@ #v2 :V –l4” Ö0ÿÿÿÿÿÿöL,ö,Ö5Öô 5Öæ 5Ö@ 5Ö2 /Ö ÿÿÿÿÿÿÿÿ/Ö  ÿ/Ö ÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ(ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ£$$If–!vh#vL,:V –l4” Ö0ÿÿÿÿÿÿöL,ö,Ö5ÖL,/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4•$$If–!vh#vL,:V –l4”ëÖ0ÿÿÿÿÿÿöL,ö,Ö5ÖL,/Ö ÿÿÿÿÿÿÿÿ4Öaöf4tDÿÿÿÿeCheck2ª$$If–!vh#vì#v`':V –l4”…Ö0ÿÿÿÿÿÿöL,ö5Öì5Ö`'/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ ÿÿvDÿÿÿÿ‘Text13�$$If–!vh#vL,:V –l4”iÖ0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4vDÿÿÿÿAText14vDÿÿÿÿ#Text15Ð$$If–!vh#v&:V –l4” Ö0ÿÿÿÿÿÿöL,ö5Ö&/Ö  ÿ/Ö ÿÿÿÿÿÿÿÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖÿÿÿÿÿÿÿÿÿÿÿÿ±$$If–!vh#v–#v¶ :V –l4”KÖ0ÿÿÿÿÿÿöL,ö,Ö5Ö–5Ö¶ /Ö ÿ /Ö  ÿÿÿÿÿÿÿÿ4Öaöf4±$$If–!vh#vL,:V –l4”lÖ0ÿÿÿÿÿÿöL,ö,Ö5ÖL,/Ö ÿ /Ö  ÿÿÿÿÿÿÿÿ/Ö ÿ4Öaöf4tDÿÿÿÿeCheck3�$$If–!vh#vL,:V –l4” Ö0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿ/Ö  ÿÿÿÿÿÿÿÿ4Öaöf4ª$$If–!vh#vL,:V –l4”…Ö0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ ÿÿhDÿÿÿÿe°$$If–!vh#vì#v`':V –l4”…Ö0ÿÿÿÿÿÿöL,ö,Ö5Öì5Ö`'/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ ÿÿª$$If–!vh#vì#v`':V –l4”…Ö0ÿÿÿÿÿÿöL,ö5Öì5Ö`'/Ö ÿÿÿÿÿÿÿÿ4Öaöf4pÖ ÿÿhDÿÿÿÿe¸$$If–!vh#vì#v`':V –l4”…Ö0ÿÿÿÿÿÿöL,ö5Öì5Ö`'/Ö  ÿÿÿÿÿÿÿÿ/Ö ÿ4Öaöf4pÖ ÿÿjDÿÿÿÿAvDÿÿÿÿ#Text18Ç$$If–!vh#vz#vÒ:V –l4”iÖ0ÿÿÿÿÿÿöL,ö5Öz5ÖÒ/Ö  ÿ/Ö ÿÿÿÿÿÿÿÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4vDÿÿÿÿ‘Text16�$$If–!vh#vL,:V –l4”iÖ0ÿÿÿÿÿÿöL,ö5ÖL,/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4vDÿÿÿÿText17Õ$$If–!vh#vX #vô :V –l4”iÖ0ÿÿÿÿÿÿöL,ö5ÖX 5Öô /Ö  ÿÿÿÿÿÿÿÿ/Ö ÿ/Ö ÿ/Ö ÿ/Ö ÿÿÿÿÿÿÿÿ4Öaöf4]$$If–!vh#v<#v4:V –l tàö65ÖìpÖÿÿÿÿyt ^û]$$If–!vh#v<#v4:V –l tàö65ÖìpÖÿÿÿÿyt ^ûa$$If–!vh#v:#v6:V –l”¿ tàö65ÖìpÖÿÿÿÿyt ^ûa$$If–!vh#v:#v6:V –l”½ tàö65ÖìpÖÿÿÿÿyt ^ûa$$If–!vh#v:#v6:V –l”½ tàö65ÖìpÖÿÿÿÿyt ^ûa$$If–!vh#v:#v6:V –l”½ tàö65ÖìpÖÿÿÿÿyt ^ûw2ÀÐàð 0@P`p€�ÀÐàð2(Øè 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�8XøV~� °ÀЀàð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@6666_HmH nH sH tH 8`ñÿ8 Normal_HmH sH tH @@@  Heading 1$@& 5�OJQJN@N  Heading 2$$¤x@&a$5�CJOJQJH@H  Heading 3 $¤x@&5�CJOJQJDA`òÿ¡D Default Paragraph FontVi@óÿ³V  Table Normal :V ö4Ö4Ö laö (k ôÿÁ(No List R>@òR Title $$d%d&d'da$ 5�6�tH u8J8 Subtitle 5�OJQJPCP Body Text Indent „V`„V CJOJQJ>B@"> Body Text¤x CJOJQJ4@24 Header  ÆàÀ!4 B4 Footer  ÆàÀ!jš³Sj  Table Grid7:VÖ0ÿÿÿÿÿÿ.)@¢a.  Page NumberPK!éÞ¿ÿ[Content_Types].xml¬‘ËNÃ0E÷Hüƒå-Jœ²@%é‚ÇŽÇ¢|ÀÈ™$ÉØ²§Uû÷LÒTB¨ l,Ù3÷ž;ãr½µÃ˜œ§J¯òB+$ëG]¥ß7OÙ­V‰�G¨çÇR®ŽªU1‡a$î°Ná»%ã ’ðʣꂣKЛÐj£VkUDRßKQj/—d޽™RéßÛ*SxM¥PsʧJ5¶$4vq^W±Cʽ D{>̳`—3üRúEBÂ=¿¦ÿüê½»Ut” Qy@Ö�›è¿\.Xœ7ôœ<:+& ‚0hõ ý@å>nÜ·Æ­BŸ ùVšq±u¶à Ç ìÑ¡{Ô5ëÞÐßÜãÜÕÇÂkP¦?ØÃO&C°¢…×  îáÃAw0²õkP†oíáÛµþ(h[ú5(¦$=ßC×ÂVs¸]mY2zì„wÃ`ÒnäÊKDC]jŠ%Kå¡XKÐ Æ'P@Š$I=¹Yá%šC%gœx'$Š!ðV(e†k�Ú¤Ö„ÿêè'íQt„‘!­x±7¤øxbÎÉJöü Õ7 oþùÍëß¼þéÍW_½yý÷|n­Ê’;FidÊýòÝþóÍo½ÿðí/_ÿ1›z/Lü»¿ýîÝ?þù>õ°âÒoÿôý»¿ûçßÿë¯_;´÷9:3á3’`á=—ÞS–Àüñ¿žÄ,FĔ觑@)R³8ô�el¡mEÜÛv|Î!Õ¸€÷×/,ÂÓ˜¯%qh|'ð”1:`Üi…‡j.Ã̳u¹'çk÷¡ ×ÜC”Z^¯W�c‰Kå0ÆÍ'¥E8ÅÒSß±sŒ«û‚Ë®§dΙ`Ké}A¼"N“ÌÈ™M¥Ð1IÀ/Að·e›ÓçÞ€QתGøÂFÂÞ@ÔA~†©eÆûh-QâR9C 5 ~‚dì"9Ý𹉠žŽ0eÞx�…pÉ<æ°^Ãé!͸Ý~J7‰�ä’œ»tž ÆLäˆ�c”¬\Ø)Icû¹8‡EÞ&]ðSfïõ~@éAw?'Ør÷‡³Á3Ȱ&¥2@Ô7kîðå}̬ø�nèaWªéóÄJ±}NœÑ1XGVhŸ`LÑ%Z`ì=ûÜÁ`ÀV–ÍKÒbÈ*ÇØX�«ê=Åz%ÕÜìçÉ"¬��âˆàsºÙI<”&ˆÒü¼nÚ| ¥.qÀc:?7��ô€/N£< ÃîƒZŸÄÈ*`ê]¸ãuÃ-ÿ]e�Á¾|aѸ¾|mHì¦Ì{m3CÔš  ˜‚.ÕnAÄr)¢Š«[;å–ö¦-ÝÝ‘Õô$$ý`´Óû„ÿ»Þ:Œ·ùƱ>N¿ãVl%«kv:‡’ÉñNs·ÛÕ _�O¿©¡uúCÙÏX·=ÍmOãÿß÷4‡öóm's¨ß¸íd|è0n;™üpåãt2eó}�:ðÈzô±OrðÔgI(�Ê Å'Büø=³˜À ’Ó'ž¸8\Åð¨ÊL`á"Ž´ŒÇ™ü ‘ñ4F+8ªûJI$rÕ‘ðVLÀ¡‘vêVxºNNÙ";ì¬×ÕÁfVY’åx-,Æá JfèV»<À+Ôk¶‘>hÝP²×!aLf“h:H´·ƒÊHúXŒæ ¡WöQXt,:JýÖU{,€ZáøÁíÁÏôž BpÍùBù)sõÖ»Ú™ÓÓ‡ŒiE4ØÛ(=ÝU\.O­. µ+xÚ"a„›MB[F7x"†ŸÁytªÑ«Ð¸®¯»¥K-zÊz>­’F»ó>7õ5Èíæšš™‚¦ÞeÏo5C™9Zõü%Ãc²‚Øê7¢ܼÌ%Ï6üM2ËŠ 9B"Î ®“N– "1÷(Iz¾Z~ášê¢¹Õ�>Yr]H+Ÿ9pºíd¼\â¹4ÝnŒ(Kg¯�á³\áüV‹ß¬$ÙÜ=�—Þ]ó§B,lוDÀÝA=³æ‚ÀeX‘ÈÊøÛ)LyÚ5o£t e㈮b”W3™gp�Ê :ú­°�ñ–¯ j˜$/„g‘*°¦Q­jZT�ŒÃÁªûa!e9#i–5ÓÊ*ªjº³˜5ö ìØòfEÞ`µ51ä4³Âg©{7åv·¹n§O(ª¼°Ÿ£ê^¡ ÔÊÉ,jŠñ~V9;µkÇv� v•"adýÖVíŽÝŠáœoTùAn7jah¹í+µ¥õ­¹y±ÍÎ^@òA—»¦RhWÂÉ.GÐMuO’¥ Ø"/e¾5àÉ[sÒ󿬅ý`؇•Z'W‚fP«tÂ~³ÒÃf}Ök£Aã'õ0»±ŸÀÝä÷öz|ïî>ÙÞÑÜ™³¤ÊôÝ|U×w÷õÆá»{�@Òù²Õ˜t›ÝA«Òmö'•`4èTºÃÖ 2j Û£Éhvº“W¾w¡ÁA¿9 ZãN¥U+A«¦èwº•vÐhôƒv¿3ú¯ò6Vž¥�Ü`^ÍëÞÿÿPK! Ñ�Ÿ¶'theme/theme/_rels/themeManager.xml.rels„�M Â0„÷‚wooÓº‘&݈ЭÔ„ä5 6?$Qìí ®,.‡a¾™i»—�Éc2Þ1hª:é•qšÁm¸ìŽ@RN‰Ù;d°`‚Žo7íg‘K(M&$R(.1˜r'J“œÐŠTù€®8£�Vä"£¦AÈ»ÐH÷u} ñ›|Å$½b{Õ–Pšÿ³ý8‰g/]þQAsÙ…(¢ÆÌà#›ªLÊ[ººÄßÿÿPK-!éÞ¿ÿ[Content_Types].xmlPK-!¥Ö§çÀ6 0_rels/.relsPK-!ky–ƒŠtheme/theme/themeManager.xmlPK-!¶ôg˜“É Ötheme/theme/theme1.xmlPK-! Ñ�Ÿ¶'� theme/theme/_rels/themeManager.xml.relsPK]˜ ¼‚ÿÿÿÿ 999ïïò ´ &�NšO$TWöWÖY !%.168<² ÷ ˜ È 2 Fˆàæ&âЀV4°NXOšO Q0SðSTîUW|WðW:XbXBY¬YÖY "#$&-/0234579:;=>?@®ºÀ ˆ”š�©¯²¾ÄÊÖÜû "$068DJLX^amps…‡“˜š¦¬ams�›¡ÁÍÓçóù1=CR^d„�–ÁÍÓÁ Ñ Ä Ð Ö  % + i u { ~ Ž j z Ô ä üKW]z†ŒµÁǼFÿ•€Fÿ•€Fÿ•„Fÿ•„Fÿ•„Fÿ•„Fÿ•€Fÿ•€Fÿ•€Fÿ•„Fÿ•„Fÿ•„Fÿ•„Fÿ•„Fÿ•€Fÿ•„Fÿ•„Fÿ•„Fÿ•„Fÿ•„Fÿ•„Fÿ•„Fÿ•„G• Fÿ•€Fÿ•€Fÿ•€G• G• G• Fÿ•€Fÿ•€Fÿ•€Fÿ•€(/1ò!ÿ•€ð8ð@ñÿÿÿ€€€÷ð’ðð0ð( ð ððB ðS ð¿Ëÿ ?ðÿÿText1Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Text12Check2Text13Text14Text15Check3Text18Text16Text17® �²Êû$s‡šaÁ Ä  i ~ Kzµ½ Á°ÅÝ#7†™­tÒ × , | � ^�Ƚÿÿ ]Ô{$^Ô{$_Ô{$ `Ô{$aÔ{$bÔ{$cÔ{$dÔ{$eÔ{$fÔ{$¦¦ÐÐßèë/ / 9 ½ ¯¯Ýæêõõ8 > > ½ >*€urn:schemas-microsoft-com:office:smarttags €PostalCode€8*€urn:schemas-microsoft-com:office:smarttags€City€;*€urn:schemas-microsoft-com:office:smarttags€address€:*€urn:schemas-microsoft-com:office:smarttags€Street€9 *€urn:schemas-microsoft-com:office:smarttags€State€=*€urn:schemas-microsoft-com:office:smarttags €PlaceType€=*€urn:schemas-microsoft-com:office:smarttags €PlaceName€9 *€urn:schemas-microsoft-com:office:smarttags€place€ ø    ËËÍÎÎÐÑÓÔÖ×óýº½¾Ðýƒ � ËÍÎÐÑÓÔÖ׺½3333S�³™¬®Á ²ß7CF’“”ôû#$7_š­Ï-u�¤ÁÕçERg„} € Á Ò Ô ü ÿ ¤ Ä ×  , i | ~ Ÿ ~ � j { ¹ ¼ Ï Ô å üK^az��´µÈÊËËÍÎÎÐÑÓÔÖ×Ùóý‰¹º½ÊËËÍÎÎÐÑÓÔÖ׺½l|¬œ÷Êÿ\ #¬t$‹ÿVdÌ+*ô]„Õ4¬ÿÚÛcží4œÿ(°dÖW"ÿIqQfLéL|ÿ…f¾iÈbÃÿ-6_m¯ì½ÿÿÿÿÿÿÿÿÿänÒ{âÔzÿ„h„˜þÆh^„h`„˜þ56OJQJo(.„h„˜þÆh^„h`„˜þ56OJQJo(.„h„˜þÆh^„h`„˜þ56OJQJo(. „h„˜þÆh^„h`„˜þ.„h„˜þÆh^„h`„˜þ.„h„˜þÆh^„h`„˜þ. „h„˜þÆh^„h`„˜þ56OJQJo(.„Є˜þÆÐ^„Ð`„˜þ5o(.€ „ „˜þÆ ^„ `„˜þ‡hˆH.‚ „p„LÿÆp^„p`„Lÿ‡hˆH.€ „@ „˜þÆ@ ^„@ `„˜þ‡hˆH.€ „„˜þÆ^„`„˜þ‡hˆH.‚ „à„LÿÆà^„à`„Lÿ‡hˆH.€ „°„˜þư^„°`„˜þ‡hˆH.€ „€„˜þÆ€^„€`„˜þ‡hˆH.‚ „P„LÿÆP^„P`„Lÿ‡hˆH.„Є˜þÆÐ^„Ð`„˜þo(.€ „ „˜þÆ ^„ `„˜þ‡hˆH.‚ „p„LÿÆp^„p`„Lÿ‡hˆH.€ „@ „˜þÆ@ ^„@ `„˜þ‡hˆH.€ „„˜þÆ^„`„˜þ‡hˆH.‚ „à„LÿÆà^„à`„Lÿ‡hˆH.€ „°„˜þư^„°`„˜þ‡hˆH.€ „€„˜þÆ€^„€`„˜þ‡hˆH.‚ „P„LÿÆP^„P`„Lÿ‡hˆH.„Є˜þÆÐ^„Ð`„˜þo(.€ „ „˜þÆ ^„ `„˜þ‡hˆH.‚ „p„LÿÆp^„p`„Lÿ‡hˆH.€ „@ „˜þÆ@ ^„@ `„˜þ‡hˆH.€ „„˜þÆ^„`„˜þ‡hˆH.‚ „à„LÿÆà^„à`„Lÿ‡hˆH.€ „°„˜þư^„°`„˜þ‡hˆH.€ „€„˜þÆ€^„€`„˜þ‡hˆH.‚ „P„LÿÆP^„P`„Lÿ‡hˆH.„h„˜þÆh^„h`„˜þ.„h„˜þÆh^„h`„˜þ56OJQJo(.„h„˜þÆh^„h`„˜þ56OJQJo(.„h„˜þÆh^„h`„˜þ56OJQJo(.„h„˜þÆh^„h`„˜þ56.„h„˜þÆh^„h`„˜þ56.€ „ „˜þÆ ^„ `„˜þ‡hˆH.‚ „p„LÿÆp^„p`„Lÿ‡hˆH.€ „@ „˜þÆ@ ^„@ `„˜þ‡hˆH.€ „„˜þÆ^„`„˜þ‡hˆH.‚ „à„LÿÆà^„à`„Lÿ‡hˆH.€ „°„˜þư^„°`„˜þ‡hˆH.€ „€„˜þÆ€^„€`„˜þ‡hˆH.‚ „P„LÿÆP^„P`„Lÿ‡hˆH.„Є˜þÆÐ^„Ð`„˜þo(.€ „ „˜þÆ ^„ `„˜þ‡hˆH.‚ „p„LÿÆp^„p`„Lÿ‡hˆH.€ „@ „˜þÆ@ ^„@ `„˜þ‡hˆH.€ „„˜þÆ^„`„˜þ‡hˆH.‚ „à„LÿÆà^„à`„Lÿ‡hˆH.€ „°„˜þư^„°`„˜þ‡hˆH.€ „€„˜þÆ€^„€`„˜þ‡hˆH.‚ „P„LÿÆP^„P`„Lÿ‡hˆH.„h„˜þÆh^„h`„˜þ.(°d²6änÒ{ÚÛcVdÌ+\ #±E 5…f¾iIqQf•Z½V—FàB>*ô]£"?l|¬-6_m& ¤SqeRCHPH…f¾i…f¾i…f¾iÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÐ÷ÿÿÿÿÐ÷ÿÿÿÿÿÿÿÿ¼Ø÷        øxVf        .tNF        n/ÐZ         å E“Bð5HTyr�}2“õG¤b° Ù ^ûËÍÿ@ »À»»p»»»»»»» Ñ ¼Ø@Ø ØØØØØØ0@ØNÿÿUnknownÿÿÿÿÿÿÿÿÿÿÿÿG�ÿ.à[xÀ ÿTimes New Roman5�€Symbol3.� ÿ.àCxÀ ÿArialC.,ÿ*à{$À ÿCalibri Light7.�ÿ*à{$À ÿCalibriA�ÿàÿ$BŸCambria Math"1ˆðÐhµSh§µSh§ûkÉÆ[p [p aßmª!ð¥À´´€24ÃÃ3ƒQðßßÿýHP ðÿ?äÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ“B"*!xx  Üÿÿ2Training, Experience and Preceptor Attestation - GDHFS James, LaurenT             þÿ à…ŸòùOh«‘+'³Ù0X˜ Üèø´Ä Üè    ,8@HPä4Training, Experience and Preceptor Attestation - GDHFS¨wisconsin, department of health and family services, radiation protection section, training experience and preceptor attestation - g, authorized user medical physicistNormalJames, Lauren2Microsoft Office Word@FÃ#@�‹ãÉ@výã0Ô@výã0Ô[p þÿ ÕÍÕœ.“—+,ù®0, hpŒ”œ¤ ¬´¼Ä Ì äState of Wisconsinà 3Training, Experience and Preceptor Attestation - G Title  !"#$%&'()*+,-./0123456789:;<=>?@AþÿÿÿCDEFGHIJKLMNOPQRSTUVWþÿÿÿYZ[\]^_`abcdefghijklmnopqrstuvwxþÿÿÿz{|}~€þÿÿÿ‚ƒ„…†‡ˆþÿÿÿýÿÿÿýÿÿÿŒþÿÿÿþÿÿÿþÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿRoot Entryÿÿÿÿÿÿÿÿ ÀF lxÅã0ÔŽ€Data ÿÿÿÿÿÿÿÿÿÿÿÿBy+1TableÿÿÿÿX¶@WordDocumentÿÿÿÿ1‚SummaryInformation(ÿÿÿÿÿÿÿÿÿÿÿÿyDocumentSummaryInformation8ÿÿÿÿÿÿÿÿ�CompObjÿÿÿÿÿÿÿÿÿÿÿÿrÿÿÿÿÿÿÿÿÿÿÿÿþÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿþÿ ÿÿÿÿ ÀF Microsoft Word 97-2003 Document MSWordDocWord.Document.8ô9²q