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FORM E: MEDICAL DIRECTOR SIGNATURE PAGE <br />Medical Director's signature is required for all proposals that request funds for an entity that is <br />a DSHS licensed EMS provider or registered first responder organization. An educational facility or <br />RAC with a proposal involving EMS education courses, including continuing education or system development <br />projects, are NOT required to submit Form E: Medical Director Signature Page. <br />Single Entity Proposals: The signature(s) below verifies that the entity is in compliance with regional EMS / <br />trauma system protocols and has medical director support for this project. <br />Multiple Entity Proposals: Each entity in a multiple entity proposal must include the signatures of their <br />authorized representative and their medical director on this page. The signature(s) below verifies that the entity <br />is in compliance with regional EMS / trauma system protocols and has medical director support for this project(s). <br />Duplicate this page as necessary for additional entities <br /> <br />(organization name) (Medical Director signature) <br />(Print Medical Director's name) <br /> (date) <br /> (authorized signature/date, if not included on face page) <br /> <br />(organization name) (Medical Director signature) <br /> (Print Medical Director's name) <br /> (date) <br /> (authorized signature/date, if not included on face page) <br /> <br />(organization name) (Medical Director signature) <br /> (Print Medical Director's name) <br />(date) <br /> (authorized signature/date, if not included on face page) <br />Page 34 RFP# EMS/LPG - 0328.1