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r1r STANDING COMMITTEE ON RULES OF PRACTICE - Maryland ...

r1r STANDING COMMITTEE ON RULES OF PRACTICE - Maryland ...

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H. Oath and Signature<br />

I have read carefully and understand the instructions at the<br />

front of this consent form. I am signing this consent form<br />

voluntarily and of my own free will.<br />

I solemnly affirm under the penalties of perjury that the<br />

contents of this consent form are true to the best of my<br />

knowledge, information, and belief.<br />

___________________________ ________________________________<br />

(Date) (Signature)<br />

Witness:<br />

________________________________<br />

(Printed Name)<br />

________________________________<br />

(Address)<br />

________________________________<br />

(City, State, Zip Code)<br />

_________________________________<br />

(Telephone Number)<br />

______________________________ ________________________<br />

(Signature) (Date)<br />

________________________________<br />

(Printed Name)<br />

________________________________<br />

(Address)<br />

________________________________<br />

(City, State, Zip Code)<br />

_________________________________<br />

(Telephone Number)<br />

A COPY <strong>OF</strong> THE INSTRUCTI<strong>ON</strong>S WITH YOUR SIGNATURE MUST BE ATTACHED<br />

TO THE C<strong>ON</strong>SENT FORM.<br />

-192-

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