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THE TREASURE COAST JEWEL A Brotherhood Against Totalitarian Enactment
American Bikers Aiming Toward Education
JULY, 2014 VOLUME #6 ISSUE #5
THE NEXT CHAPTER MEETING
July 30 @ 7:00pm
American Legion Post No. 189
807 Louisiana Avenue, Sebastian
ABATE IS NON-PARTISAN AND WELCOMES ALL RIDERS
MEMBERS OF NCOM and MRF
OFFICERS
CHAPTER POSITIONS NAME PHONE # EMAIL ADDRESS
PRESIDENT STEVE KLIEMISCH 772-778-8130 [email protected] VICE PRESIDENT SUE HULCE 772-480-4776 [email protected]
SECRETARY ROBIN PHILLIPS 321-412-7646 [email protected]
TREASURER PAT MAZORATI 772-453-1755
SERGEANT AT ARMS DALE GASPARIK 772-260-3880 [email protected]
MEMBERSHIP TRUSTEE SUE HULCE 772-480-4776 [email protected] PUBLIC RELATIONS WENDY CAPOTOSTO 321-537-8964 PRODUCTS TRUSTEE TIM FLYNN 772-581-9544 [email protected] SAFETY TRUSTEE JOHN BUTLER 440-666-5527 [email protected]
LEGISLATIVE TRUSTEE STEVE KLIEMISCH 772-778-8130 [email protected] STATE DELEGATES STEVE KLIEMISCH COMMUNICATIONS TRUSTEE LIZCA MATHIS & ED YOUNG 772-473-9385 [email protected] ROAD CAPTAIN DARREN “WIZ” CAPOTOSTO 321-506-3078 [email protected] CHAPLAIN KIM "Shep" GEMEINHARDT 772-913-5549 [email protected] NOTARY PUBLIC ED PARKER 321-537-9282 [email protected]
STATE BLOOD BANK ACCOUNT
#1138
COUNTY BLOOD BANK ACCOUNT
#VABT
CHAPTER EMAIL [email protected] CHAPTER WEBSITE UNDER CONSTRUCTION
TABLE OF CONTENTS
Calendar 20 LIST OF ADVERTISERS
Classifieds Acorn Storage 6
Disclaimers 3 Dog House Lounge 5
Flyers 22 - 26
Earl’s Hideaway 16
From The People 8 - 15 Jeff Mathis Services & Metal Works 6
Letter from the Editor 17 Perfection Auto Service 6
Membership Report 19 V Twin Concepts 6
Membership and Renewal Application 29
Milestones 6 - 7 Minutes 4 - 5
Officers (State & Chapter) 27 / 2
President’s / Vice President’s Report 18 - 19
State and District Reps 27
666
Information for Business Ads
TREASURE COAST CHAPTER RESERVES THE RIGHT TO EDIT ANY CONTENT POSTED IN THIS
PUBLICATION.
Advertising Procedure: ALL ADS MUST BE PRINT READY. Email ads to: [email protected] Newsletter Deadline
Ads must be prepaid to ”ABATE of Florida, Treasure Coast Chapter” and submitted no later than the
20th OF THE MONTH to make the next month’s issue. The advertiser is responsible for all copy and ad
changes.
Advertising Rates for Business Ads
FULL PAGE $282.48 HALF PAGE $141.24
QUARTER PAGE $77.04 BUSINESS CARD $38.52
All advertising rates above are for six (6) months. FULL PAGE (ONE TIME) $69.55
Goals and Purposes of ABATE
TO issue a newsletter to keep all bikers informed with regard to legislative actions and events around the state and throughout the country. TO become a powerful and viable political force in legislative matters concerning all motorcyclist’s rights. TO provide a lobbyist to represent ABATE of Florida, Inc. on the state and national level. TO promote voter registration and motivate members to write their legislators. TO promote safe riding habits without infringing on the individual rights.
TO educate the public about motorcycle awareness.
How Does ABATE accomplish its goals?
ABATE of Florida Inc. is a non-profit, grassroots political corporation composed of local chapters that have been
organized by motorcyclists, to promote a positive image through local, civic, charitable and benevolent causes; pooling
resources for the common benefit of the members and promoting political awareness. ABATE exists to monitor
legislation and testifies in your behalf during Senate and House hearings. ABATE collects, processes and exchanges
information that may concern you or substantiate our views and places it in your hands through a newsletter or by other
means of communication. Who Can Join and Why?
Any individual 18 years or older interested in motorcycle rights, regardless of their race, sex or club affiliation.
It doesn’t matter what you ride or even if you ride. To join ABATE ensures YOUR opinion on motorcycle laws
will be heard. Membership Benefits:
As a member of ABATE you may receive discounts on products such as:
1 Motorcycle parts and accessories (from participating dealers)
2 ABATE runs, events and functions
3 Motorcycle safety school for endorsements on your Florida license 4 You also receive a STATE and CHAPTER newsletter.
Newsletter Disclaimer: This publication exists to inform its readers of legislation, events and activities pertinent to motorcycle enthusiasts concerned with freedom of choice. We
encourage submission to be in good taste, true in content, and free of libelous or slanderous statements. However, the views expressed may not be those of
ABATE of Florida Inc. and its Board of Directors, or that of the Treasure Coast Chapter.
NOTE: Contributions and gifts to ABATE of Florida Inc. are not tax deductible. DISCLAIMERS The views and opinions expressed in this newsletter are not necessarily that of ABATE of Florida, Inc. or the Treasure Coast Chapter. This Publication encourages the views and opinions of its members and sponsors. ABATE of Florida, Inc. and Treasure Coast Chapter accepts no responsibility for opinions, views and/or comments in this publication. The Editor reserves the right to edit for length, Misspellings, formatting and inappropriate language.
ABATE OF FLORIDA, INC. AND THE TREASURE COAST CHAPTER DOES NOT
CONDONE DRINKING AND RIDING/DRIVING.
Identification Statement
Publication Title:
The Treasure Coast Jewel Issue Date: Volume #: Issue #:
July , 2014 6 5
Statement of Frequency:
Published Monthly Name and Address:
ABATE of Florida, Inc.
Treasure Coast Chapter P.
PO. Box 1360
Roseland, FL 32957-1360
ABATE OF FLORIDA TREASURE COAST CHAPTER
GENERAL MEETING
JUNE 25, 2014
The meeting was called to order at 7:06pm.
PRESIDENT: We are starting a new year and I want to thank all of the people who sat up here last year.
I also want to thank all of the trusties also, without all of us we have nothing.
We had 8 guest. Welcome.
VICE PRESIDENT: No report. Wanted to thank Pat for stepping up in middle of last year and thank
Robin for coming on board this year.
INTERIM SECRETARY: Minutes from last meeting passed around.
TREASURER: Treasurer’s report read and accepted.
SARGEANT-AT-ARMS: No report
MEMBERSHIP: We have 162 members. 1 new member and 1 renewal. Hope to sign up more on July 4th
.
CHAPLIN: Had to work.
LEGISLATIVE: We have a new President Doc Rickenbach and Vice President Mudder.
We are here for Motorcycle rights but we all need to get out and vote and let our voices be heard.
Chance drawing of cash tickets will be divided into 3 winners next year instead of 1 winner of $10,000. It
will be 1st place $7,000, 2
nd place $2,000 and 3
rd place $1,000 minus the 20% that is taken off the top of
each prize. If you are winner you will receive documents for IRS stating that taxes have been paid
already on winnings.
So let’s sell those tickets.
SAFETY: Safety Booth at Riverside Park on July 4, 2014. We have it covered.
PRODUCTS: We got our screens. Now will get information on cost and get things ordered.
NEWSLETTER: Out of the country
WEBMASTER: Still a work in progress with a lot of progress made, gallery up and running. Please
make sure your event flyers are turned in early, they are only loaded into web site once a week.
OLD BUSINESS: Meet and Greet at Pennwood motor lodge. July 20, 2014 starts at 11am. BYOB, BYO
chairs and bathing suits. The meat will be provided. If you bring a covered dish you can drop it off the
night before if you want to ride on Sunday. If you bring a guest and they sign up it will only be $15.00.
Set up will begin between 8 and 9 on Sunday. Blast will come out after the 4th
with information.
NEW BUSINESS: None
GOOD OF THE ORDER: July 19th
Armed Forces of America M/C of Cocoa is celebrating Bastille Day,
On August 16 they are having a Happy Birthday Celebration, free food at these events while it last. On
September 13 they are having their annual Strip Poker run, sign up starts at 5.
Spirit Riders will be having Church in Rockledge starting at 11 with lunch ride after.
Don’t forget biker church 2nd
Sunday at the BIN and the 4th
Sunday in Fellsmere.
Meeting adjourned at 7:52pm.
Check on the traffic before setting out on your trip: http://www.flhsmv.gov/fhp/traffic
To Report Road Hazards
Indian River County: 772-770-5085 Brevard County: 321-690-6840
ABATE Breakfast and Sunday ride every 1st Sunday of the month
At the Dog House Lounge Next date: August 3
MEMBERS MILESTONES
HAPPY BIRTHDAY and HAPPY ANNIVERSARY TO ALL OF YOU CELEBRATING IN JULY!
PLEASE EMAIL YOUR ANNOUNCEMENTS TO [email protected] by the 20th
of the month prior to the milestone:
Rick Staub - July 9 Louise Cross - July 10
Richard Therien - July 29
Wally & Debbie Baldwin - July 10
TREASURE COAST CHAPTER
JULY 18
We encourage our membership to send us any type of information to be included in our “FROM
OUR PEOPLE” section of the Jewel. If you have pictures, a story to share, a ride of a lifetime, etc. just email it by the 20th of
the month to be duplicated on the next month’s Jewel. Just email you pictures and story, preferably a jpg format for
pictures and Word for the text to [email protected]
We all would love to hear from you!
LETTER FROM THE EDITOR:
Besides the fact that we are having a great weather here in the Treasure Coast and we have been able to ride, we need to be aware and careful out in the streets. It is very dangerous with 4 wheels so 2 it’s even worse. Also, it would be nice to see more members step up to the plate and participate at our meetings. I am posting here some numbers on who to contact for information at State Level. Once again I’ll be editing your Jewel from Panama for August but always available via email at [email protected]
KEEP THE SHINNY SIDE UP AND THE RUBBER SIDE DOWN!
This was in the Tampa Bay Times yesterday...
I just want you to know that they are coming at us this year... Educate your Chapter members that the
people who want to take away our rights are already gathering for this fight.
This next legislative session may not just be about getting our safety money back... It may very well
be a hard fight to keep our rights from being taken away... If they take away our right to choose a
helmet, how hard will it be to prohibit "loud pipes", and raising our insurance cost?
ABATE of Florida, Inc. will respond to this editorial, I doubt that they will print it, but we will respond. I
will also share with you how we can educate our members to respond correctly with facts and not just
antidotal claims that the other side freely uses.
If there is any way that you can attend the Leadership Seminars, please do.... It will be important and
I will devote much of my Legislative seminar to this topic and how we can come together with one
voice.
See you there...
Scribe
Legislative Information Center
ABATE of Florida, Inc. Legislative Hotline
1-866-FLABATE (1-866-352-2283)
Email: [email protected]
ABATE of Florida, Inc. Legislative Hotline
1-866-FLABATE (1-866-352-2283)
For information concerning:
Chapters, Events, Public Relations, Safety, By-Laws & Board Info, Visit: www.abateflorida.com
Editorial: Legislature should require helmets for motorcyclists
Thursday, July 3, 2014 12:15pm
It was clear when the Florida Legislature repealed mandatory motorcycle helmet laws that the decision would lead to more deaths and injuries. Now history shows that opponents of repeal were right. Fourteen years after relaxing its helmet laws, Florida has become a poster child for pro-helmet campaigns around the country. Motorcycle deaths have jumped dramatically from an average of 160 a year before the law was repealed to 457 in 2012 alone. Those numbers rank Florida among the top states for motorcycle fatalities and paint a grim picture of the cost of riding without a helmet. As Floridians enjoy the holiday weekend, drivers should particularly watch for motorcyclists — and motorcyclists should wear their helmets.
Motorcycle activists campaigned against requiring helmets for years. Most states had mandatory helmet laws by the mid-
1960s, when Congress threatened to pull federal highway money if they didn't comply. When Congress changed its
position, helmet laws began disappearing. Today only 19 states have mandatory helmet laws, and fierce battles are
underway in many states to roll back those provisions. The debate heated up in Florida in 2000. Supporters of repealing
helmet laws argued that helmets gave riders a false sense of security and endangered them because they blocked riders'
sight lines and prevented them from hearing ambient noise, which made them less alert in traffic. Opponents of the repeal
spoke of loved ones who died in motorcycle accidents while riding bareheaded. Others recalled suffering from debilitating
injuries because they did not wear helmets or talked of walking away from accidents because helmets protected their
skulls.
The Legislature repealed Florida's mandatory helmet law in 2000, allowing anyone over the age of 21 to ride without a helmet as long as they carry at least $10,000 in personal injury insurance coverage. Since then — except for a short period when the state required mandatory motorcycle training — there has been a steady increase in the number of injuries and fatalities among motorcycle riders. Ridership also has gone up, including among older riders who increasingly are involved in fatal accidents.
The vast majority of fatalities in motorcycle accidents occur among riders who do not wear helmets. Already, pro-helmet campaign leaders in Louisiana, Nebraska, Tennessee and Vermont have used Florida to dissuade voters from repealing helmet laws.
In this age of distracted automobile drivers, wearing a helmet when operating a motorcycle seems like common sense. It shouldn't take a law to enforce safety, but unfortunately it often does. Like seat belts in cars, helmets save lives.
Activists wary of losing the freedom to ride without a helmet should weigh that right against the costs of death or injury to
the families who have lost loved ones in motorcycle accidents and to taxpayers who often pay when crashes result in
visits to emergency rooms. The deadly results from repealing the helmet law are clear, and the Legislature should revisit
the issue.
PRESIDENT’S REPORT
July is here, we had a safety booth in the park for the 4TH, and I would like to thank all that helped out to
make it a success. For ABATE to be a success and continue doing its job as your MRO, we need you to renew
your membership when its due, or earlier. If you ride and feel that you should have the same rights on the
road as others, then please sign up, and bring a friend to join. Power in numbers. Your board members and
trustees will be attending the State Seminars in July, so to better help our members and learn some new ideas
that might help our chapter.
Don't forget to mark down July 20TH on your calendar as we will be having our annual Meet and Greet at
the Pennwood Lodge, across from Hales Groves in Wabasso. Party Starts at 11:00AM, the chapter will supply
the meat. There will be a hospitality suite, so bring your suits, they have a great pool. Chairs and covered
dishes would be great. If you need to drop off something the night before I will be blasting out what time we
can get into the room
RIDE HARD, RIDE SAFE, TC Prez, Steve
Vice President’s & Membership Report by SUE HULCE Well, for me any way, it has been a pretty quiet month. My choice. Sometimes you just have to let
things pass you by, can’t always be there and participate. And, yes, this month, I let it pass me by
and boy am I paying for it. Catch up time.
I want to thank Robin for taking on the secretarial position and Pat our Treasurer for taking care of
the minutes during the time we did not have that position filled. Your secretary is one of the most important
positions. I am glad to be an active member of Treasure Coast Abate. I believe in what we stand for and I will
support Abate. I want to thank all my friends and fellow members for allowing me to spew off at the mouth any
time I can in support of Abate. I know I have pissed some of you off and I don’t mean to. Sometimes the knee
jerk reaction just happens!!! Please know that I mean no harm and just want for your freedom of the road.
That is what you feel right!! Well, guess what, government wants to take that over. Watch, you will see. A
little piece at a time. OOPPS, there I go again.
The 4th of July Safety Booth went well, a special thanks to all the members who helped out. We cannot do
this without you!! You know who you are; YOU are always the ones stepping up!! THANK YOU! It was a hot
day and we were able to tear down just before the rain storms!! Woooo Hooo, another great day.
WHO JOINED IN JULY...........IT’S TIME TO RENEW We are holding steady with around 169 members. I know I tend to “DOG” some of you for your renewals, but
you love me, I can feel it!!!! Passion, passion, passion!! Don’t you feel that way about your dog??
WELCOME TO TREASURE COAST OUR NEW MEMBERS: John Dastous, Jeff Norwood, Steven Kliemisch,
Jr., Johnny Hahn, Elisa Mitek and Zachary Reynolds.
And of course, always thank you to our renewing members for supporting their rights and this Chapter:
Sharon Parker, Linda Avveduti Roger Norwood, Doc Clark, Kim Gemeinhardt and welcome back Jack
Harrigan!!
APRIL MEMBERSHIPS LOST: Tom Becke, Ben Gentile, Patty Petroski, George Rozas, Charles Bell, Jr.,
and Ricky Lett. (Really Tom, you’re not giving up on us are you?)
MAY MEMBERSHIPS PAST DUE: Restituto Gonzalez, Wayne Herms, Bill Sandford, Joe Wood, Rob Yates
and Jeff Fisher.
JUNE MEMBERSHIPS: Cheryl Varney
JULY MEMBERSHIPS: Daniel Coyle, Daniel Gladieux, Ron Bernard, John Finnegan, Donna Flynn, Eddie
Jones, Lizca Luna Mathis, Sue Martoccia, John Zban, Bernie and Mary Call.
IF YOU LISTED ABOVE, PLEASE RENEW. THANK YOU. REMEMBER – MEMBERSHIP IS EVERYONE – SUPPORT YOUR
CHAPTER – THANKS!!
HIGHLIGHTED ITEMS INDICATE A TREASURE COAST EVENT
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
JULY
1 2 3 4 6
6 ABATE breakfast
7 8 9 10 11 12
13 14 15 16
17 18
Bike night
19 AFMC
Bastille Day
20 Meet &
Great
21 22 23
Board
meeting
24
25 26
27
Biker Church
28
29 30
General
meeting
31
AUGUST
1 2
3 ABATE
Breakfast
4 5 6 7 8 9 ABATE
State Meeting
10 11 12 13 14
15 Bike
night
16 AFMC
Birthdays
party
17 18 19
20 Board
meeting
21 22
23
24 Biker
Church
25 26 27 General
meeting
28 29 30
Fellsmere
Every 4th
Sunday
9:15 am … Free Cont Breakfast
10:00 am … The Word
ALL are Welcome… ride or not
Hosted by: TestiFire Ministries Shep Kim (772) 913-5549
Location: 12420 County Rd 507 (Babcock St)
¼ mile south of C54 Bridge, Fellsmere
Look for CMA Tent & Biker Church Signs
MEMBERSHIP Grace Lord PO 2520 Deland FL 32721-2520 (904) 504-6362 (386) 943-9610 (Fax) [email protected]
MASTERLINK EDITOR C/O State Office PO Box 2520 DeLand, FL 32721-2520 (386) 943-9610 Fax: (386) 943-9610 [email protected]
LEGAL COUNSEL Larry Crow 1247 S. Pinellas Ave. Tarpon Springs, FL 34689-3719 (727) 945-1112 Fax: (727) 945-9224 [email protected]
LEGISLATIVE Darrin “Scribe” Brooks PO Box 2520 DeLand, FL 32721-2520 (239) 398-7145 (386) 943-9610 (Fax) [email protected]
PRODUCTS Steve “Caretaker” Knee PO Box 4372 Milton, FL 32572-4372 (850) 529-4446 (386) 943-9610 (Fax) [email protected]
DIRECTOR 0F SAFETY EDUCATION Charlie Wenger PO BOX 2520 DeLand, FL 32721-2520 (954) 650-1420 (561) 333-6773 (Fax) [email protected]
LEGISLATIVE HOT LINE 1-866-FLABATE (1-866-352-2283) Toll Free Inside Florida Only
WEB PROBLEMS Dan “Slo Mo” Henderson [email protected]
2014-2016 BOARD OF DIRECTORS
STATE OFFICE ABATE of Florida, Inc. PO Box 2520 DeLand, FL 32721-2520 (386) 943-9610 (Fax Same) [email protected]
PRESIDENT James “ Doc” Reichenbach PO Box 712 Silver Springs, FL 34489 (352) 625-6353 (352) 625-6353 (Fax) [email protected]
VICE PRESIDENT Dennis “Mudder” Rudoi PO Box 2520 DeLand, FL 32721-2520 (407) 925-4307 (407) 699-9748 (Fax) [email protected]
SECRETARY Shelly Johnston PO Box 2520 DeLand, FL 32721-2520 (904)405-4700 (386)943-9610 (Fax) [email protected]
TREASURER Patti Nasrallah PO Box 16309 Temple Terrace, FL 33687-6309 (813) 695-9203 Fax: (813) 626-2306 [email protected]
SGT. AT ARMS TJ Painter PO Box 2520 DeLand, FL 32721-2520 (352) 303-8299 Fax: (386)943-9610 [email protected]
PR/COMMUNICATIONS Sarabeth Kohl PO Box 2520 DeLand, 32721-2520 (904591-4100 (386) 943-9610 (fax) [email protected]
Office of Governor Rick Scott
State of Florida The Capitol
400 S. Monroe St.
Tallahassee, FL 32399-0001
Lt Governor Jennifer Carroll State of Florida
The Capitol 400 S. Monroe St.
Tallahassee, FL 32399-0001 Citizen Services Hotline: (850) 488-4441
Executive Office of the Governor Switchboard: (850) 488-7146 [Office hours are 8:00 a.m. to 5:00 p.m. Eastern Time]
Fax: (850) 487-0801
Senator Mike Haridopolos
District 26 -- Republican District Office:
3270 Suntree Boulevard, Suite 122
Melbourne, FL 32940 (321) 752-3131 Tallahassee Office:
322 Senate Office Building 404 South Monroe Street Tallahassee, FL 32399-1100 (850) 487-5056 Senator Joe Negron District 28 -- Republican District Offices:
3500 SW Corporate Parkway Suite 204 Palm City, FL 34990 (772) 219-1665, FAX (772) 219-1666 [email protected] Tallahassee Office:
306 Senate Office Building
404 South Monroe Street Tallahassee, FL 32399-1100 (850) 487-5088
US CONGRESSMAN BILL POSEY
Washington DC Office District Office
132 Cannon HOB 2725 Judge Fran Jamieson Way Washington, DC 20006 Building C
Phone: (202)225-3671, Fax: (202)225-3516 Melbourne, FL 32940 Phone: (321)632-1776, Fax: (321)639-8595
Indian River County: Phone: (772)778-3534 Toll Free: 1-888-681-1776
ABATE of Florida, Inc.
Treasure Coast Chapter
REP DEBBIE MAYFIELD District 80 -- Republican Capitol Office:
REP TOM GOODSON District 29----Republican Capitol Office:
REP JOHN TOBIA District 31--Republican Capitol Office:
317 House Office Building 222 The Capitol 209 House Office Building 402 South Monroe Street 402 South Monroe Street 402 South Monroe Street Tallahassee, FL 32399-1300 Tallahassee, FL 32399-1300 Tallahassee, FL 32399-1300 Phone: (850)488-0952 (850) 488-3006 Phone; (850)488-2528 District Office: District Office: District Office:
1053 20th Place Suite 1C, 400 South Street Suite 508 Vero Beach, FL 32960 Titusville, FL 32780-7610 1901 South Harbor City Boulevard Phone: (772)778-5077 Phone: (321)383-5151 Melbourne, FL 32901-4770
Phone: (321)984-4848
P. O. Box 1360 Roseland, FL 32957-1360
Date: _________________
Name (please print legibly): _____________________________________________ Membership Number _________
Mailing Address: ___________________________________________ ______________ _
City: ________________________________________ State:_____________________Zip Code: _______-_______
Phone Number (include Area Code): ________________________________
Are you a registered voter? Yes N o
Please list your voting districts from your Voter Registration Card:
________________ FL House ____________ FL Senate _____________ US Congress
E-Mail Address: ___________________________________________________________ for weekly updates
IF YOU WISH TO RECEIVE THE NEWSLETTER BY MAIL (not email) ONLY, PLEASE
CHECK HERE_______________
IF YOU WISH TO RECEIVE THE NEWSLETTER BY EMAIL (not mail) ONLY, PLEASE CHECK HERE_______________ EMAIL: ___________________________________________
If member of more than one Chapter, please declare your home Chapter
- Check the box that applies to you:
New Annual Membership ($20) Life Membership ($150) Transfer Membership from __________________Chapter (attach a copy of membership card) Change of Address
Renewal Prime Member ($20)
All members receive with their paid membership a membership card, our monthly newsletter, the State ABATE bi-monthly Masterlink magazine, Chapter voting privileges, and personal involvement in statewide legislative actions and their freedom to ride! SIGNATURE
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D ue s pa id by: Cash Check # ______ Money Order Amount $________________
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CHANGE OF INFORMATION FORM
OLD INFORMATION: NEW INFORMATION:
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Phone: Email Phone: Email
SIGNATURE: _________________________________ DATE: _________________________