Telephone Fax E-mail Original Signature Language of CV one-pager attached □ □ □ Yes English French Correspondence Administrative Lead Mr./Mrs./Ms./Dr. Name Title/Department Organization Mailing Address City Province Postal Code Telephone Fax E-mail Original Signature Language of CV attached □ □ □ Yes English French Correspondence Project Lead (overall project team lead for all communications with CFHI) Mr./Mrs./Ms./Dr. Name Title/Department Organization Mailing Address City Province Postal Code Telephone Fax E-mail Original Signature Language of CV one-pager attached □ □ □ Yes English French Correspondence Evaluation and Measurement Lead Mr./Mrs./Ms./Dr. Name Title/Department Organization Mailing Address City Province Postal Code Telephone Fax E-mail Original Signature Language of CV one-pager attached □ □ □ Yes English French Correspondence Physician Champion
Telephone Fax E-mail Original Signature CV one-pager attached Yes □ Language of Correspondence English □ French □ Administrative Lead Mr./Mrs./Ms./Dr. Name Title/Department Organization Mailing Address City Province Postal Code Telephone Fax E-mail Original Signature CV attached Yes □ Language of Correspondence English □ French □ Project Lead (overall project team lead for all communications with CFHI) Mr./Mrs./Ms./Dr. Name Title/Department Organization Mailing Address City Province Postal Code Telephone Fax E-mail Original Signature CV one-pager attached Yes □ Language of Correspondence English □ French □ Evaluation and Measurement Lead Mr./Mrs./Ms./Dr. Name Title/Department Organization Mailing Address City Province Postal Code Telephone Fax E-mail Original Signature CV one-pager attached Yes □ Language of Correspondence English □ French □ Physician Champion
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