alla Name. -1-- P,C.1[49./r Client Telephone • Call Back Name- O) 1 Call Back Signature ilt e Call Back Datertime I / L4:2.1. 7µ,v. C% s' ..onal Hotel Approval Obtained 0 I Not Aprcable K DDA CO entre Approval Obtirted 0 Not Applicable K ID: 036012072789547 DATE: 12/07/2010 21-.32:00 Page 1 of 8 DI