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Portal : Capiz Destination Guidebook Please sign items for approval. Photos File Name Signature Main Photo ________ _________ Sub-Photo 1 ________ _________ Sub-Photo 2 ________ _________ Text (please see attached) Contact Details Please complete the contact details Complete Name of Property: _______________________ _________________________ Telephone: _________________________ Mobile: _________________________ Fax: _________________________ Email Address: _________________________ Website: _________________________ Mailing Address: _________________________ _________________________ Price Range: _________________________ ______________________ Authorized Signature

Guidebook Agreement Form (Capiz)

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Guidebook Agreement Form

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Page 1: Guidebook Agreement Form (Capiz)

Portal : Capiz Destination Guidebook

Please sign items for approval.

Photos File Name SignatureMain Photo ________ _________Sub-Photo 1 ________ _________Sub-Photo 2 ________ _________

Text (please see attached)

Contact Details

Please complete the contact details

Complete Name of Property: ________________________________________________

Telephone: _________________________Mobile: _________________________Fax: _________________________Email Address: _________________________Website: _________________________Mailing Address: _________________________

_________________________Price Range: _________________________

______________________ Authorized Signature

Washington State Telehealth Implementation Guidebook · 4.5 Duty to Report and Civil Commitment ... • Case management with interdisciplinary teams ... A Business Associate Agreement

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