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If you are 13 or under 13 years of age, you must have your parent’s permission to complete/submit this form. To reflect that permission, kindly enter at the beginning of the form
1. your parent’s first & last name; and,
2. date and time permission secured from the parent listed in #1.

Provide NO details of a personal dilemma. I may have a current or past client with interests adverse to you, creating a conflict of interest. Submitting this form will NOT create an attorney-client relationship.

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