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%W <br /> <br />FORM E: MEDICAL DIRECTOR SIGNATURE PAGE <br />Medical Director's signature is required for all proposals that request funds for an entity that Is a DSHS licensed EMS <br />provider or registered first responder organization. <br />Single Entity Proposal: The signature(s) below verifies that the entity is in compliance with regional EMS ! trauma system protocols and the <br />medical director supports this project <br />Multiple Entity Proposal: Each entity in a multiple endly proposal must include the signatures of their authorized representative and their medical <br />director on this page. The signature(s) below verifies that the entity is in compliance with regional EMS ! trauma system protocols and the medical <br />director supports this project(s). (Duplicate this page as necessary for additional entities) <br /> F <br />(organization name) j(Me;d1 Directorsignature) <br /> (Print Medical Director's ame) <br /> 5-41,z <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 signatureldate, if not included on face page) <br /> <br />(organization name) (Medical Di rector 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 signatureldate, if not included on face page)