ࡱ>  3bjbjSS 4J11E\::84.!"bv L}!!!!!!!$#&!V"@bVV!::B!V:R}!V}!C "k UDʕ^[ i!!0!c 'TR'k k 'E!$VVVVVVV!!VVV!VVVV'VVVVVVVVV : Please note the following: This form is to be completed by a referring physician, patient, or a person the patient has authorized to complete this form. Please do not complete this form if you do not have the patient's consent. This form is not designed to respond to medical emergencies. If you are currently experiencing a medical emergency, please contact your current health care provider, dial 911 or go to your nearest emergency room. A representative from the Transplant Program will contact you within one business day. (* = Required)* Referral is being completed by: FORMCHECKBOX  Patient/Designee  FORMCHECKBOX  Referring Physician * Reason for Referral: FORMCHECKBOX  Kidney Evaluation  FORMCHECKBOX  Liver Evaluation  FORMCHECKBOX  Heart Evaluation Patient Information:* Patient Name:* Date of Birth:Address:Street 1 Street 2 City State  Zip Country Work Phone:Best time to call:  May we leave a message?  FORMCHECKBOX Y  FORMCHECKBOX NHome Phone:Best time to call:  May we leave a message?  FORMCHECKBOX Y  FORMCHECKBOX NCell Phone:Best time to call:  May we leave a message?  FORMCHECKBOX Y  FORMCHECKBOX N* Email Address: Referring Physician Information (if applicable):Physician Name:Practice Name: Address:Street 1 Street 2 City State  Zip  Country Practice Phone:Practice Fax:Practice Email Address:Other Information:* Preferred Means of Communication (select one):Contact the Patient:Contact the Practice: FORMCHECKBOX  Work Phone FORMCHECKBOX  Phone FORMCHECKBOX  Home Phone FORMCHECKBOX  Email FORMCHECKBOX  Cell Phone FORMCHECKBOX  Fax  FORMCHECKBOX  EmailPatient condition/other comments:      Transplant Program Referral Form PAGE  Page PAGE 1 rev. 09.28.20 Form may be mailed to: Transplant Program Hartford Hospital 85 Seymour Street P.O. Box 5037 Hartford, CT 06106 Or faxed to: 860-545-4366    ! " # D E S T U l m { | }      2 3 4 5 D E F G H X Y Z ۖj*hlUjhlU hl0JjhlUj2hlUjhlUjhlUj\hlUjhlUhlCJaJhl0JB*ph hl0Jhlhduhl54   ! " D $If $$Ifa$?kd$$IfK{*{*64KaKp $$Ifa$gdl & Fdd[$\$gdlgdl   3 @Wkd$$IfK0{*&64KaKp$If $$Ifa$WkdD$$IfK0{*&64KaKp3 4 D F G X Z XWkd$$IfK0{*&64KaKp$If $$Ifa$?kd$$IfK{*&{*64KaKp Z [ e p q s ~ @Wkd $$IfK0{*&64KaKp$If $$Ifa$Wkd$$IfK0{*&64KaKpZ [ n o p q | } ~           $ % 9 : V W e f g {jehlUjhlUjhlUjhlUjhlUjhlUjhlUjhlUjhlUjhlUjhlUj hlUj hlUj^hlUhlhlCJaJ0~  =7$IfWkdz$$IfK0{*&64KaKp $Ifgdl $$Ifa$WkdH $$IfK0{*&64KaKp  @Wkd$$IfK0{*&64KaKp$If $$Ifa$Wkde$$IfK0{*&64KaKp  $ & | $If $$Ifa$okdl$$IfKF{*6    4KaKpg i j x y z | }  ' ( ) * : ; < = M N O P c d e f q r zj,hlUj*hlUjp(hlUj<&hlUhl0J5\ hl0Jj#hlUhl0JB*phj"hlUjF"hlUj hlUjhlUhlCJaJjhlUjhlUhl0| } $If $$Ifa$okdM$$IfKF{*6    4KaKp (Wkdr%$$IfK0{*64KaKp$If $$Ifa$okd2#$$IfKF{*6    4KaKp ) * : < = M O VWkd'$$IfK03{*&3H64KaKp $$Ifa$?kd%$$IfK{*&{*64KaKp $IfO P Z e f h s @Wkd[,$$IfK03{*&3H64KaKp$If $$Ifa$Wkd)*$$IfK03{*&3H64KaKpr s t +,:AOWYZ\]klmyzj?hlUj>hlUjhlU hl0Jhl0JB*ph hl0Jj*;hlUj9hlUj6hlUj4hlUj2hlUj91hlUj/hlUhlCJaJhl5s t v @Wkd0$$IfK03{*&3H64KaKp$If $$Ifa$Wkd.$$IfK03{*&3H64KaKp @Wkd8$$IfK03{*3H64KaKp$If $$Ifa$Wkdb6$$IfK03{*&3H64KaKp @Wkd<$$IfK03{*3H64KaKp$If $$Ifa$Wkd:$$IfK03{*3H64KaKp )+,.CYaX $$Ifa$Wkd=$$IfK0{*64KaKp$If?kdR=$$IfK{*{*64KaKp YZ\y$If $$Ifa$okd">$$IfKF3{*36    4KaKp$If $$Ifa$okd?$$IfKF3{*36    4KaKp@ABCDEFHIKLNOQRSՕ草}hF4CjtDhF4CUh )jh )UjhlUmHnHu jhl5U\mHnHujBhlUjBhlUjAhlUhlCJaJj@hlUhljhlUj@hlU,$If $$Ifa$okdA$$IfKF3{*36    4KaKp$If $$Ifa$okdxB$$IfKF3{*36    4KaKp@BC}%WkdC$$IfK03{*&3H64KaKp$If $$Ifa$gdlokdtC$$IfKF3{*36    4KaKpCEGHJKMNPQSuv^gdlgdlh]hgdl &`#$gdlgdlStuvw}~0123޿޿޿޻ޯ޻h4dhlCJOJQJaJhlCJOJQJaJh )hF4ChF4C0JmHnHu hl0Jjhl0JUhlhF4ChlCJ OJQJaJ hF4ChF4CCJ OJQJaJ !#0123gdl^gdl 21h:pl/ =!"#$%` Z$$IfK!vh#v{*:V K6,5{*4KaKp tDeCheck1tDeCheck2x$$IfK!vh#v#v:V K6,5594KaKptDeCheck3tDeCheck4tDeCheck5x$$IfK!vh#v#v:V K6,5594KaKp`$$IfK!vh#v{*:V K6,5{*94KaKp Dd h\  c $A? ?#" `2 I $&Dt:`!I $&Dtr(@|xm 0Dg H8ܕ۠) PHȲ=;` ; 4d9F1KaqXU9ªeB!ʵĄ쩥8Rܞ3U]"eB>J^U1i?xۤ'vYbt&x$$IfK!vh#v#v:V K6,5594KaKpDd Uh\  c $A? ?#" `2 E:/5<ön`!E:/5<ör[@: |xm 0Dg H8f PJ PHȲ=;`  fœsjKaqXY9ªea )UM$&dO- !Rܞ#U]"eBJ^U1i?xۤ'vYbt S"x$$IfK!vh#v#v:V K6,5594KaKpDd " h\  c $A? ?#" `2rCEQݴe`!rCEQݴer8|xmK!DVg6r oŭ:e&1.w0C0ܨ9a:bÕ/>8,NxK*GX2B(T6=rBj3cٚ|&7B*KLSrSWɫ*&oz8,NxK*GX2B(T6=rBj3cٚ|&7B*KLSrSWɫ*&oz8,NxK*GX2B(T6=rBj3cٚ|&7B*KLSrSWɫ*&oz8,NxK*GX2B(T6=rBj3cٚ|&7B*KLSrSWɫ*&ozI}!]%R&])Q{UMzyk=`g%F/#zDd h\   c $A? ?#" ` 2 f<y<*"/7<`!f<y<*"/7I}!]%R&])Q{UMzyk=`g%F/#zDd h\   c $A? ?#" ` 2 f<y<*"/7<`!f<y<*"/7I}!]%R&])Q{UMzyk=`g%F/#zDd h\  c $A? ?#" ` 2 f<y<*"/7< `!f<y<*"/7J^U1i?xۤ'vYbt&l$$IfK!vh#v#v:V K6554KaKpZ$$IfK!vh#v{*:V K65{*94KaKp Dd h\  c $A? ?#" `2 I $&Dt&`!I $&Dtr(@|xm 0Dg H8ܕ۠) PHȲ=;` ; 4d9F1KaqXU9ªeB!ʵĄ쩥8Rܞ3U]"eB>J^U1i?xۤ'vYbt&x$$IfK!vh#v3#vH:V K6,535H94KaKpDd h\  c $A? ?#" `2 h0;V7(`!h0;V7r 8&|xmK0 Dgli+Xpܪ<@J ABNLtء)-*3MhucS} סQFIȲb&eɤ+XnI 2I_DgW0Eg?7uvh&ا/ }W.x$$IfK!vh#v3#vH:V K6,535H94KaKpDd " h\  c $A? ?#" `2rCEQݴe*`!rCEQݴer8|xmK!DVg6r oŭ:e&1.w0C0ܨ9a:bÕ/>8,NxK*GX2B(T6=rBj3cٚ|&7B*KLSrSWɫ*&oz8,NxK*GX2B(T6=rBj3cٚ|&7B*KLSrSWɫ*&oz8,NxK*GX2B(T6=rBj3cٚ|&7B*KLSrSWɫ*&oz8,NxK*GX2B(T6=rBj3cٚ|&7B*KLSrSWɫ*&ozI}!]%R&])Q{UMzyk=`g%F/#zl$$IfK!vh#v3#vH:V K6535H4KaKpDd hN\  c $A? ?#" `2  9[q`h(/G9`! 9[q`h(/rt|xmK!DVg6r oNG4טp`DT րi!+97jvxQJl'с%#ZVRDbBRB!홱lM>I}!]%R&])Q{UMzyk=`g%F/#zl$$IfK!vh#v3#vH:V K6535H4KaKpDd h\  c $A? ?#" `2 I $&Dtn;`!I $&Dtr(@|xm 0Dg H8ܕ۠) PHȲ=;` ; 4d9F1KaqXU9ªeB!ʵĄ쩥8Rܞ3U]"eB>J^U1i?xۤ'vYbt&l$$IfK!vh#v3#vH:V K6535H4KaKpZ$$IfK!vh#v{*:V K6,5{*4KaKp r$$IfK!vh#v#v:V K6,554KaKp$$IfK!vh#v3#v#v:V K653554KaKpvDeCheck12vDeCheck18$$IfK!vh#v3#v#v:V K653554KaKpvDeCheck13vDeCheck17$$IfK!vh#v3#v#v:V K653554KaKpvDeCheck14vDeCheck16$$IfK!vh#v3#v#v:V K653554KaKpvDeCheck15$$IfK!vh#v3#v#v:V K653554KaKpx$$IfK!vh#v3#vH:V K6,535H94KaKpDd+!  C `AHHartford-Hospital HH logo 2020 jpegR/]>Qs DF]>QsJFIF``XExifMM*1>QQ.#Q.#Adobe ImageReadyC      C  " }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?(((((((((((((((((((((((((((((((((((((?.7^S5~WN?/)oC2|>H(,(+C.ռ%r&uMCLN%H5EL%tU:/Sό#_J$%cul5$L?}*Y<G$kDqns`mcf51E|sVazj*54~ž/q&GR*5j]aQ+y7G?J+ 7G RMUqyAF?9%U]O :_q|Gj%gq])P~}%i(|`((((((((((((((((((((((((((((((((((((((((?.7^S5~WN?/)oC2|>H(,(uKjV6poXp\ @H \Aa%ֽ=n8W|¾3rEdu lҿ*ү8ˌq9.&:P$۽Ӳ>8/֝:WUM]箊b^x6-iDp*md¬$$&hŝַv3*RC+)0 B+xoV4?ɟǞ\+X|e ki%OkԂJ6&_ .n49dokUx3ǐTuH]W.x{Śqoh7 @q$d:Sƫ8f|^}~L8· toٷQwzļ?z~׭|SX2,ZwVFX}AWӳH(*QwOc:@>ξ>~$բ";[{&6Wt7? c|tǽUk8 4쟩b3*Ы(+Y3ko|A?,oZ+Zt7? cO7-D{Cߊ(p>((((((((((((((((((((((((((((((((((((+ '_loz-SFKEkr+︖ fb?5kةTrINV?hqzCG8=x!#d_2#? ?<d?#N,O$4Ë'C׈?#d_2 _HWGccfW|gៅ<;kSwSKX&h%Y9ǭ}_xLE*)9(ŧt_33. ͸sABSjR+tl+ /6<ʣU%`?Wrǽ~WٿVf_h͠,Kk*RSW25;SinkMG5x`RB-SIW?hqzCG8=x!?#d_2#; ?<d?#?3?'f}YI6[$(?JJ_u~Z>T-m.&9QQǘۊx$uVWZMmۜ+al&VjZ=QKtǽUk{ '{`?5ğ5_c?/P+9(ߊ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( (εg.{B \\JE {F!۲,_v|/u5xPh;j&Ow&_xJE4?lķ!9 v3kcYsBxqq祆hM3Bf|~ic%VoJe[s*p+"% 8KuΕIR[OhŠ(3 ( ( (?)டx M|_O]?gF>CyzQ^!QE~QEX}QEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQExao7)Xol-17`"A90>fPvFu*TvGV[^8l xzռPV+N3*I-bK-z$Z߉GV{:ۣ x{S/>B|Din]tD\ul ;Wap#>=4KRT?Uiʟc?&WǏ(.4~x(kZds@P仚᭍€E&8"h9q=H|"?m?sC?ַm oz0Ii{psy9f_?f ' 7P< ڥI_1qN5߶M.{J*R/=FS۬Q1gWO̳i:%Ylc 00/#h((((((((+ѿs6? d߂Ӵ4Ih#1C6XWA_˿'SY~S9Ok^𧉼C%晨EXFq $Ð~?kv?kvoBpOž7.a"ZD;1䎀k??qO)O#M_> EG&`Edô66_-]cE%WQEQEWi+$4XճlO82ʤ1ڿinό~߱O[Z,@pcy07, l8')EygY?[Yz6Q^n?mڏC{}ڎs޷=ؤJyHZiʭGev~ݍRa牮&GU+ ~ݓjY3yLSIX2[30ʠ ӯA4WZj }ΫKV+s <~ fzviVv+xaUGic13~N薏ֿ"fgz>.rZ󷑑? wAM;EmmAPXprMkE|ۻ)NR݅QH(((P==coh=k4Dc,s+; uƟ}kPJ&} Ai"lI!`}ExOV k"lž"ں^/feUNT㥺5.m|'\oUVCQ$fyÁu_x}ʚyunehzue~Uk¨O ^ tMcMև%ŝX LFT_)pG@+cMw f;= Xe%I#~qV=cm+y@>Լ3/|mR%M"Зd*Nvuq/I/㵲;!3$IŒ |*D<6yUuKRI}uQN(((((((((+W~~ߴύ­uS7[Yqmݕ%Tk/-gK(dCf(6O}㠻[<49u,}T &:,~?Oqv: mq( 4?&7euug0LluҭFA{Q@~`ܟ}$N\=xamAn<ٽوD<>?=He6gXelo`mր?*'¿ .ɮx7kSiNz[MQp?4kC (9m_??ҞI[~KW/Ѿ&x'΃eڮAi',PHft3kӿxʝw>ۈe'vi6?OkRCi(YE+6r+?z_̿ &_ 35/چykX^F%et=M/^4 1]ye(' wʹ{>:]},.8O5fURMJs'ϻ[i/nci$qgbpI_h~?J-[v~"Ƌ b[1_% ~|9sxkvJ0u+%3&}++2?iђIMdN6RЫv~ѭt:% ( VII%d{_)pGk.txddW,]MVw #SJ?BW?^:?BW?^>ࢊ((9PV_s㎿?:PM|tFFDiV#>\:??_ _k_g+^u_ g |n|D|Aa^:ȶRpP7WA_ l`e/.~e!qϷJomc^3F~vA#瞇W?Ioڋ.?E}p2FQ ?tW'6i^|AC3z|Gk^k^=HgW_qu*?YDx6A2SVzwP|=>់?xfK2J^) 두+??SK?GOoOx~i6ZG!\LrZ69? +?h ן߄>&x.|3M2-N5qE 7 NFs 9GkT&5i|7 Hv&8 F9O[Y:gQdy_4?j߲?YK8[φ>(hދI<$Ӭm^+kvEh/&s!{o< ))jw0i:W=Nv IixU ĞOj?h+S|OGš:u |ԟYc¢x+ټ?^i~0qk~# p-cY2y䉱Tˏ.7Uچ ?!&8A:W~lhb?uPGɧx{)?3náh'':Fkr~z3)eYِI.nl.]OiX~_#VA?Gο_(_ 7ŏ,[R#gEcw@B &n+Bo٣z:\j𾙢^KiiOo,֑C#F[QV(Y Ioh#VA?Gξi?T [⦏[O6 Č2lqWͿKdTқ[?Lk~ {xX/t2K9;Dj E8~L\_W|)Ӿ{&7ou+5̷)l"=al g|ѿP5)z ?o ?fh5X؟ٿX]yb|\?knہ (~տeh_Vߋ _Ï |LuO [Ě}j.bS`sj&?+?o8Edx/¿%&eAQEwTM/[9^|;3j2&m_ʳٗ,k4=sƓx$t+۸8+,&e 1uJ 0(CmZ=FfMHQVe7__o3-흮G-Āmq`3_ϥ~Z_ Hak3"_gkQ 6d8hfUU&{bQo.BUVky]H*AEF_nGyGk?? X^-@1ݦ` ?&^xAд>{[t_DpP`$?u?O6[F,Ѓ@HB=#u@ W  += ?K{K_?j򼟳ϻdvܘݓcnOτ3xϋ 6.n) H@,T?gƭMl2[Rד -ݣEtdzQɯ?)_T/ڟZKFtE?7`d' XYxO˝CLSN-fnm-A8cK[_~z%>Kk$i!e179dU'K5[[+X۫VSp]*G'|Vx->HZ 5q~G+u BNCƽI=u$ {o=v*iÞ2~/oJl $}iAe^.'v|=x``Hpqv<M~VԟyZ͇/žBSA'ՅY@i58('i(qթƭ<dNTOs+ axzfoV+8bp$}]^_` QMG{t]牝pmF̨J~Q^_rli__rli@Wc{ s.a¾KR]j !xۂ9F#޿(a?._fxha?._fxk?7g?7g?*(>zdG =[?ğٺo#:ş|b_ZGq$E~D:T҆4raw>,W_)q`oMoP_?|C e:"oGMCnsXl30 Ǖ[_j xgŚo=alž zΪ$lqFq8TP8C<-G#ff~ÖM؋?Eq_}f=W71pMOr$3-8uGeEܟYZfh_ZZ=t˧';s2913N1g3PĞψ.bR໒4;URB䓁I5= u+M.͠mu+@Je$pz_Uo!kne@rGz?W=}3~:M[=e0QN䵹WmkAdssMciq]Ekkȱ JYrp('yKOUi:oQ rH+(HK9F?ge&Ϟ_h"QKg5Ce2_Gz?{[qtռ]|KVdVz8?"SԱ?UPÿۿدvWt=%Ώ^O1{W7? gxgKȬo[^R5u`Uz5Q@ 'm?T2Cі6VYXO-ⷉ5[DE pAX)_>E> #o>ZR&ЭeLY3zI$kMXgbP 'm?kx7_>P|+ߴfsi68%wqp+8ois]^PԾ'Pqss4y,K1Iɯ_=K|2ׅ;/5MmnLa3hczd_?|_º熿?߄>ľ4EmOM+Lv8_uKh _&?gᓾ3|o=Bk K>ɖm7KI fA+j>;^?g߂1浟hi0Z ~_V{@WNzw5 5ᣅ sG4& +\>2x~&7 s3syZWsv{L.5J nXa%,TI$?Fψ_WZ?>O4:r9a0Gr1X(IfQL_(^K[\16;hYSȄQzIo$ 6`2ZK]GP&EkKvE5y|&5ᮡep6os)bg8eh՞ ԵfoLh% [_P[fߋ!kׯaX\$U2!ee`H sLtMJ{;9Vh'CȤuaʰ G a>?>cgd<WVU2@sQ_m8wxgI 9׋Xnqq7hwFvW^,?rjz|#jSY.{{(‚d9eA?mψ nYt^D>PT(:Kc^ş<1 }x_|P{7JWZ-TS*a_MOz?Ut4kWiW.Z9֖7½k\wWY;)k+ 㫫&?3+H 7٭b3l!ʢR7"ʟ{~g]_;YX9sʤ.<' ~>WTм#`/KR,ؠg?57 X5/w5P _pto7uնmyZFbkt<:(yV8՞G!UTd= CQΫ wg }6&,mw6O&%4 ˧߷oX~o+fgabc򧟃 5SP='~ xN <'ڀ"}>+X8Tpڶ=2Z [,3F$Ee<jz(^|?_<3ZlQjz V./"Q<0bUи a?[v+7tO9E@fRMS K65OPEPEP_OGa?Cj//Q~$KxK"G_%D(ࢊ(:qɅ!VD{UxL/%kګwO?͟ŹJgRxCl_ LG,#ꦼ*o+-дgD`>OAg|_Y7M%?7^=[_ѓiFouo#Eqk"A}ܿ8|"֬vTY4QE3EP_ ?kV%kw>-J^Go+*(ُ启B|-+B|-( l]:|JIQ 5 Ed2>X՛ڿ6>߲+I$lB^Yiqw]ȓ`'mWQįk>2NٞQp;F0ƽ8¢@3Lֵl绻q0I\UO #;NS@bHՁj8,θyib6A<{˥'Ûi j7[=iscng7{|񅭍WKx*܇HYA3 cxG/އ7}t}I9d{Gm~Ξ5Y'_X:]?N ݕb#y:C|U[Ɨ e4jy4pku wJXq2N_Vk>c y`_|~ohF8 $L91_=((pH4@}a.vᛨEů%PA+,zz= [bzkRo෿ 0YМݹns@%Q@Q@T n/KhJ`>&5ʯܰ&?_?kqMXgbW_콧ͤn#hn-|1,mmbQEW_/2)_{tkJ>smw Cc+º熿1Ioa] DP|7&|Jo7+CMѐyUmmdQd$kJ4?"I 8^>=~ib*|'d|?u ƶųx;I>`!76~wDXX/qk=unUJ((k"'wuRʓU8c~N{sWb!i4J,M* YQ mx?Z ?nKJKFHnt"xڿ4/ x G? $?)?$wOcoahVYxʮboEh+ӏ4w,n]B&O~VMSg?>'MxZҜn0٢qx%`9_Op&,uj 69@9򺜌}Az(? _+޿*C?$ 䑖OJӢPwK1lNj^6.SJlk j_OO)z ( (<;h)֬4it |C<3[]SI* ˆ"vk/ .ya;y]kuBObAZY/m˷|SCA٪wۛѭ%FM? WyMum=k*G!AH9% 8Y?)ՅH*qjSOfTvh|y#mSE!MWRknxfMnRfJd\.c=+ȨfXPxhԗ{vǛW!jb㏝:Os.Q\'QEIokVsG *D~Oq>6"?@(Y 1]ehFG]fB1*;+: )?kEG@ Wy6*d"?r2PQEQE~sڄDO#Gޣ2hU|)#n򄯈?o_~ofnx<ygWd_u_P_eKj%̒7U> `2oK8ty98 r雧Jkx#1\|Eֵ4uKO?7 #<2Bu;}~^eҭ"Y$~V'A!Ndy,T"Y_wYhv~6fSug=+n:W ʌߙ%+i 5/|IV ){Bq qޒF豠gcvcsr53@8/ wʴe'E&g# ٭dl >}Q{mZ,\MHK1Qqp* Ĺ%K7t9YM'6csoF4POk1nOW((pH4@~_ q_5Yhmip*.W,ޢ|[xrO5->V1\\$Oy.\A.A;W'Я>smw~k5?k?_пM<5ZD| {sGCw7IWJ o{ qv=֡FWv1ݦ1ҔP]Wϋ?Cc {@WߴDxwƚUa(?72 ó%YO* vUp( |fhFBV"j =Kr30V|]OXx~"|UR1-^Gwk:H2:QE|+i\#RXoat|,C6>Vu$Z  F w^l[oG<ԾwbV+Y{3%ѰR8??& kx~ |^/I-<6n2D++%Ԋ~տ^X=w\ M([*Jԃ|@d1>,6 hv2N_Vk>(?7-gm h ˀ:c!'kV/=>x֋f]|<}&4,Op1 )׭??ɯھZgKh:~0`fd1EmquA/~WY<'gg/t$)c'qi!8l%EaOo))K_|0Ej̉Hp \rhs((*(YJφ7מ,,InN>T%+̪ 6 6;a\ZknY=msr$m9.1od+q1'lў+ҿi7ƿG70m[>: |-%$(FIڈ'53 BxW[vΡE9ns|:2R%Zz(((((((?h/?-+Pucľ!3j䗗!gv'&>?W?}?GA1QjalOk7nnNH9F8 : 2&>?W?}?GA1Qjc $_w+q K-w%nim#kȒùE'O5 _o H?7oxW^0m+it3pc#U'К+)~*~?%@w 7#!?<+T}Gs*8bm@];xX>)ito4jD 6w^IrX CWGY3^Z +N4=bdWHte$`A?j> w_|?gK0R-KE%T$B%r(fi̧(y'$[J,sG!$nxTku6u7Jqp(=<co'F>=k?eQ0zI/?/Y3j|yjϭr}O%"Wb5Ѡz"ܨi{5~:?}%/'K/}ehmLؤIXA">8/5MD[xM |#uzuqܨSkfϯƿ'?|;8E+ G$>L`$(cE<*/`8? Uz#P _۞W#!?Şןmj^4ƅ De1U%sTq['_x[>0x:#[񖣨X]r,M3FdDq2)k4WXm>7^ukYfY3 c1\#'q3)c~8F>o(Gx!'5MUMHaM +ag~F E_5~pؿjo9oWCL|~(+Eb]Kij>E{H_%QuIWU߷ E=? 'ihM;g_hAYRBWqX+?e'WyEǞ$.u].Ɨ$ќ2Y?W?}?@G~9⟏_oiNÖB$<(F`1@Ýv?h%|sLA{7:lh]Ink&Qj7,ڶZ-#Ɛ wm+{bξ&nEZUҼMLyp㎥w_- Siz\.%p7Vi~Qo7ex.aSH1Do οVO)4:aV.slV"0ʺ~f/kǟf5-f;<3-zfPJmBK1M~W7f t^k-ܥɍKg8:KO?> ivk'/k{iR9uW̻ Fpk{ E_5*Gg7'eoBR%Z֓-jw*H@b@<L)%)'k kD־%xrPu\˪[$RH kcޣ韱o h|Gվ&|+G%嵣;n$=w@@ s@ЕQ@~^ voxgZ|^c0.` :rC  A?x 'Fhz7Z~yfmϑ) u :qr g5~Пjڧ~#xcJww_ź6u`CG"VD*yR4V|exVƃZ&be\[D!_w[u6{~ΟDό;"Y!`nX|6&kPo+ޗ=.)p$Q4'Դ>;\XȞSUdS>x]kח7.dy2I+}M~/Zm:pl[& Q:s1X9 3ĺo?h_Z|N4Vx1|:>$f\l(qWRV?:JcßMseִVMBK'$~6!.»1kp~ZOZo|QlqZ}AuJĬUBT^8  Uz#PO߳_5߇>85FP޳s]MnΎд:;F^8ء8&58ʌ}џ???(>5x÷Ƶ↏鰵obQy$x$+Lo~)mnGEcDgC$ 1 p~Wm~VMuEPEPEP ū/|*ֽ⏅<7XlNxf{iY#T]ʣ$e-WȕL;Pۣς7-ow=K-vOP1mg5u{)a[6];EPEPEPEPEPEq`渷kºn2-ͨj ;q$ɻ# H:ee3^I.om7IލN{w? v{ݤa.mm߼BUdragQNxKWRJ}Ugd@?\'_t-q0Vx,daEP"3 59/)$ixca=Kkt<7>7Hf4rjz~^g1hRG+jQtpba%ėwM4,ww;I=W# e~{JB7Il$|A`7.+4ܐU)PM~_n$ڝ/ ^.[J5뙜t˜x۾b<8? lÞм?oyIa"g;@@<ր? +Wt?\Ѵf+ ; 0 Ǐ"_H̾(ϸͻ4o$< 200KSog5_ bŦZ4Kknh&)U:W'c/67Eׯ-#g.R($D' dk GK{/%gQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEL/:;Scm+y_cm+y@pQEQE(J`/9_?͢ ;MnTHhp.>(5S3u~uQN(|;;ᮻjz|3e.MH#R팓8N(l. Wz_+h^$v] @W5re4?,+:;[ω^T;qoA~U=.4^Uc\G*gUY8=m8?|#MW;y-Ԫ=0@'/gD7ƶ,x i~I M}iws$sA2 #6 )s_=~?Kio5?Uw3hӝF"'!X)MZ]_6GUu`due` uW~;˪|LȬоCd8"G`ҷ( Ϳ: S 3}/q Su-"!+r+y$͗@avĿ]u߈7+aҼIOvׇ% skdnU9$Wxq5mmҾ N˻Y3 9ԑ'?m+uC5k}WE ,x8–@yzf:;uxtk /HX8X\@[ǏY%Q_xSźW7ehzK=\[]F܇D%YOb +:m&'~/XP?hOeѱ_PBث/: . .˩r~L9G]bTᔌA@?ࣿ~|e X3digC&l9PGkcVrן_kclw~.O/Ty?jmv KZK̖.̑ !?7g?<'2^8N>թqXC~tҸD]be $ 鳴zd.O‍0̬@d?" u~k{|%E'kpFjvq/bT~ه.ocNvI}uéiVkiZs+u?s^:ş |i~bzU3ʟ~)t+W__)|Qr|sh%RɓO[]Ð2+s K e!gDŽTë+[j[$D"FRC+`o|PQE|U+N=KIfn Y$z@?=AnFzmu6̤yWIww-ԓ$M3$F,19$$Z| |Rٯ5iv{XAvQGl@|TSPwGo-N,3M*[[n )*N"toFTU2e)ÉҼ A R?/*{iI[: ( (??NWZ^~5oe/jƧ/AԵk/.mWRS41wb,In|~ɿō > 7>+ȼ5+P IOG4W1>;~.k,Z,:1 ~!-*ewD d} u;iֵhm%?f)ǃ|Mx@ xsnֽ{`z9O=>'x^.x\Ԥ3]:ܗwwNzK{Md+uoVqE~|kkKk+Ft@OL~ƭmSᮧxBtsm-xy{?CC4=OM"Yn&YUԕe#A O"W֟_j~(/\<-,; !"_Ta&V"aV/Ï3^%:lۡJ<|ma?g?'G dviڶV:yT_7b7g?(??ON7@E r3^f?f(=C?~$am/J[T8̺3.!]QU/[ɋ^&>T'V >8tKOTt>a$؅UP $S_ #BԼ][P,Q#`yI}1O8~D]s W[\;jwQ?y9npR72-hn8jZê8ͥڸ"ӮvkS9<xFj~ۿ~)x Pbm>K),a@pbHр R X%|5M/y< r&ݥ!x 6A9ր>xGs{s:dFkCQK[[HWW!Q}؁_7W?߳&22jk Z]P H"8c IH!(>Z5P#M|JEɥx_OvEל& -i:;IOk V),^ M@=㕇|ǩ⾑l |FI(a F(hcϞ!|5}qk>gn;c8?୿,? (x^6om侟 ť¤Ee5oAׯ-Z]ޛi%ŭݬ ҡ 2 ~4W7|m|tյgM?8p~XicVMe~PEPEP_[oo}fcq__e|A_W) 'A~+-mVN=Ŵ4HPıcKg"P9 EZw,=_¾q?Ǩ| -;WEVrSF IaNҼMeywq]Ӥ}G#;mEf8 *(C WƭGpd1ek!v΍{=벿5SkZ.+ޠ; yG,?u'¾ xod|$ш#+  yϿecA> uѻnaqT5)bux5jZΣ;|ۋZY<4?iwaOzoׅf+kGjH!6W*)?bgGyk IE=$?r2އsVz?t }/C,t(lVvƱʨz  f_å;a b!AecP]2Y$I<8̟i MD/moB?tȤH*yk?8 a|q |Gᙦ{|20TW&I-wFW,VX_įZ?ZEciVi'ܹ6Xϳ#0kPϿx%Ch.Z\;dx؏3 myƭ4RO &<$&ma{tIF|gKqV'Bb~˿g~#l˫x]85&¾%4cN\iWҎE"FT@|_º熿8o,O3//u [KuQ^m| Y#I62@ԙO=WuQN/?Bo Ś|桩\Iuu+gQdy@5 Jm0~9#PKR6y d)rwHZo4MI-/~$iv.SQ\BQMkh ,A ǝEn⿆|xڭn%Xb^< OwuZ @a] T\!* t ُ Exj/x?Wƪf9`QEQEQEQEW96s_k4?_"_g/ kۦ}_w쏻v><2 K?_ 1x|a /= cǛ}^.6FI5OA1Qj=ľ t9F{ ig%©ʏN20h?CiZ;h0\Ǐ'wEM|FyY)VMgH7#F 2`W@/ڞW8K@ZUĭq'HYX{yU$_,Vfޕ;__W㕽P^iۻamqV_pt&zί[X5ɧٖm̺u$nv1eAԴmi63?'{WI@R4/ |3gIϴԢv }'X|ݏՍ~x||Q[iڕ.-%,.I>5_򂏎ԃL wؚS?~Zއ}x _$FKKU2q_)ɨO4m4,]0V#pmր=+>>#?t߇ 7w_@ )e؎J2[:"Ӽ!:}f?>9dG?8HI7 i4` bCG%:dQUKxi\ei8`ޔ A!/wTnaKet> dT'uN<-@iX ,@NWZO<*n'ܵ{\1ɲD5Uap$P_x fx^%վ ItM.6o&7$ax'k_wxcÚmֱçi6˺kˉ\$q3>_f쉧pFk 2ũ3A 8m*( |h&ū{8惡 <:V%(#Q- ',Zn>v6o cpգE|l!g(/4 <=qܡX|AZ6W5vo7#+Q$Y.׼~!0cUR"BB̫"HEhU\Zoe׾_LΖK&wrć -Gh2 {S;)Mo|Hg2oēJۦK=IxW__g/;u {|<ஓkwVgث^C'`K5>IQEQEW!m~>VM!m~>VM~8߇;Ʃsƚ5)-ti!bU#_ (g(?o\> kA!pO YE -?ƿo x Ej~ t:.>թZٶCm[a;W_tw? +5SkZ.+ޯ @8Vˊ85&||mEI҉CR~㍳}][oH?ϡܼq|ڱB߿QPW?f:ˠW"L#9^P "z?$/k?S5| ~ʗio~g/46ԲA+:g5C|T7@H_Lj?$/k?S5}C|T7GA S|A!~__kK ,j;>뚇ttg郳nUo{eA.=eyǀ_5W~N~W>dOjқxzu]۝>\H>i%VfDo ):]e{MNPr` |_1O? f5ώ^յaO6K٤91׊yữ.|@`%,`>6sgm06Y@& ǽCZ#9B>` ;clg\~5hnVd?W~,O'-r?8!}_:u lG%a#ae{⏊Dڳgs> xþݻ]jw% 1a#ʕ=LW~q$tI.?m:dZx";fSK=ha? 'm;%78϶kͯsC%||UN?_)qG:h_b +w}715=AWMW_)M;N~@;m$5/(X_?դM!dP^VVFߥ~EW(Ja]Nv?_v+7tO9E_z_ -'m~ {iϩk.|m2XH= o4M ]avz.4htq@ֵQ@|GѿOo&z_#h'=u#S%=@܋(u-(%En 2iNAPE_|.gڃM?ZitKw_kϓ|n=xX7_ |CB粔P޳ Po_jĈ~k[8X9b26<=I /vɯκk,č7|Iai8'G.2쨬xKZ:YC]wGuo4k$r){Ԡ(((++HٳArGE6rfl@]nP :>[EԵKM7Na5gwbTI$_~qOk9^Ki|nFH?!^GQ$H+iW9KuqPޒf2XnCҗ9U1RG̐ƀ?&=?_|@8I-4+b:dzz$yx~ NRnnmʞ$=e߉׎p4 Hmϵ{-KojIz;ٷ<,I( 5rhc./TY.V,yKiz`&Կ?7KY㏃"σ|?˨UiV%-=sӚj?oo:*YY1'CNFǣ豤FV;*+:;PQi|G >9R 2?*_>ARR&Z_˹g&xhu>ƾho5;IQ+e-%<$6.'呇>sQEWpҭk:Ppi'Js7u5khS[u6FS+&PF8:`65n}/ i:lgo'wg.6=7F7÷Ӗ-Nyދ-dyDm| tF"Bx:g#W7O.Sw4?|?ME)?_]oO5{ž&6z.a]H%KG+' E nƏ)A^;?WPI񽆗2/~"r?!*pH?__/wE/?|ax 2%0'M~QEQEWSY [ / #~ ? ͫdhOQ +ïce4z\T`xK1'ܚ((ο:YKV=5+]ÐW}ѯE? _+޿**KiO-Of7C֮%y*ld}/AC2Z/J+Yi&OD藺G3]nm41ƿ+=/?Qx>kzG~˙%>8܃aєdWAUF~#ג/fILg•>_߉Ɵuu_NմȾմH>3_ ~?q!6~:jY=k;猋VvgYyY71JU/xNgiZ·sQ0ʼn)A @Q@){Ti־(k䮃ż/4ih% ++# y#3?kOfVKiv!w;v}OuW}}[煿ߴU- Uwor!k*?7S?|7ex9R?;KX2̘ CF" #'ZU!aEDPTz R_L|^ 𽇃E4}m,|ō&\IP??_d%%b~sy ^G+Od?tjڵ]__][XD\O (#PYٰTI' 9i)7ƽԾ:y%>_r#s("83r2N_Vkvkx1 "+Lׄ}@ Q@򄯏 ӝu򄯏 ӝt)qG:kU1q~ v]3^ŏo+=[R%Zw|:efagm uH~;[zkG//ƺr8[ssR W{~kt?EXyqmuo䴋w`nEP_v+7tO9~aݷAjו$tYS[fJO h*)+U?S ɿ~}V-KX#~8ꢊ(A;'*J)(5|WshE±ɡAlCFomcrG:^jc {xPg#p\$zMyUcd)qG:kkF>"|k]z7y0.W=+bioO*6 Fq^ VVʉS=cv]H _ѧuU>r]k[?EK:!Dku%ςxױfjؒd9! +H?P]Jgo2Gߠ{)$cy>X2(_!_ |'y?1o#G5Wz^>-jSbE̩c32@r(E+7rC֯=gx֛&ڽ Ndw*p ~YW)U?RP}_O_j__%K'ʾ fg7=\Q${Wyn*'-|Nʫc%:@:? |5x?ƿ ~>ώ!4]W_lfMۿ5đH*eTPMkFڳ_7C<5sk'9g궐ΙarcxPVk  GJ:Uz ER'4x~V/촭+L/o'X-!E,I#@hiij:O WR(=㑌nM,</Y&L &kМ,*pǚQ2h p&!|O>ɨuF=jT~P_򂏎ԃL:;PQiW)q`oM_h҆4 7m|7@EQ@~~|o |3GG<; @=2<_ 'VkziХ oVrGҀ?b?l}7xj^~2hIji?l>x$`r@?,OZeq5ܶ7֓mgI̬؊<'K)uK4kom1i<4|x-N+;csۏnQEQY/7ֿ])mkj7I#IS>(S~uBIJE+(Y$wYppQEQE$?EIifhOտ|K^+ubKtR$G €+q+t=GBm8g7\~O#r6Ϳi;q9NxoO j3ǜw٦h2(ӿMS:DŽ5纵Vn,dIjx<1q+t=GBm8gbs'㍿ok9#S$\dW~mM{z-]/UWr42!P?m'·Lկ5[|w]|:R a5Ȭl3!<;tï=%5鐲ZN - iªܕe@2iO٣_mko >f1=6DIu _۷# m_ u=⿅c.lQK,\Z1n ۞Ln& F c2~5|//5~,qk}7St]iS2Ɂs,Y<?_'.I 5Y_$@<5{3f/;:?Fy/0g ɴzI˟=ڃ CRض76>>MCI'4(\vu?Pg|>/\=^%;R{ ]}:$|`px+ٻ 1[ )Ӝ:_^Cd&R9G7 Pd/V09;U`w|Ǟ#珵 OkEm$\89{hg 2kJ?< ժ|7_3CmO:B(ZN05q[Ies_o^~ao լ:7G:A`C#*Ho|Sk?#`o!)ʨz9??jDP jIU4rmXYI&B-oڲH[gXu13M\{Wį& vK| d%υ/^$pjÿ'_wmែ?5NTCw8jrXz?:\?oWK99ދS` # >#y0zb"T|Y09xRBj:6vl( 2jn[ |t?J_$O_ltxub'چy Iqq!G@ r@M} R31_||_ \Vdh#3zW DVzq+t=@g_:g?3ukVxzGx,2$5qE<q__p Ծ".խt_kuw70 ga V^@"5@_w x3gi:?4{ R 4_~,/-ȍ,n9bn7G" _Q4GT/j>2xI^KXt]BOnr8P勑y~{ ܐxŭHq Du#"?D=Hfc^OK<& WƟ|W<#\V|hox]Hˎܜ'Gba16^Y[T ˒H#=k !?hR~oÓ2Zw&;;gf9&xzu=~'9>fIƚ伹PR$RlĕfS KA>\|:'Z[[Vne"[O}p0fSI[$:56a IYS!qy_? DVz?8kؿa_<>&f^O YrZ$?kLJ? DVz= )~#xE<]:~yQ:DIRyR鮿O&_]\~͟P?<]=vj1OෆuwaJYPxPI鮀>_^0~&xPKl-n8]mbcoF5q/Ud|?xG{H˘VFSH9r}~_N.umBdN#EoRVbB#IS4ˋx-hXRA>zֽc^$1~Z j/{,inr6[ e&Mo'.~7b kf1Y{T{W WM˟ߏRO\/)5''|;>$A}c9e݆ 2HC+( {^ K57\\dJn ?H/qχ?)aIa_sK#K1$: DVz>q}X>70.9M?}_ZEyFdQpI85Bm8g -(x;I|)m6\W%F3ÿJ/]nu:6 a÷9Wfݭſ }-kO,c9zW &?쵥)Fj>s=uqq1 +-Ur8P2O$((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((:`|%G♴?|QunQoY]DRH)9| -;PQ^? EZw`i~jV>׷ omk#rI xW.?ӿ{?\~e~:jV X&C-u -МuتNh(((((((ۯ'f?khH+xkV!BFda 3UfE%=O~^+~%࿂K~/PhyLuLI#5.rl6□Fw̭vCqsךꨯ3 l>|eS%ŞGn}oW:#s*N3c}ks(((((+)n?kP^Oi_Z]"SEU€?j+?p?"/"O7[7#xRw-GVS`̑_`QT: (+?? |k^.]95mUۅS$ɠ +_N¾q?Ǩ(co|r50<:& 2 `9tQ^o#¯](zϴگțEu܌2UX?\~e +ȭ_o.#V1ә&J(((((((((1?*W?twmx➣qǮ"G^ ;bEr.F+(HϿW?KkkdyGt7֥ew 2̌2g*0cO/KkB5amc{G7fe@EPEPEPEPEpݟa^%Lj^-JM2ECxEhc O.x-al8O_lkO~%|[g|/7u;4BThZXRI8?( ( ( (?8 +H~տV?xxšmB1,x+wPI6FX۪2~W_*^%jHo[Ox: Rk{*gM?,Hkl?AGAwᇈ>55>9xGºUֹO/R>5Đ2h q$_ǿGxCO+|17}Z>R;'XQMqUɂ(n||x75->~KK 8VU,ȻXdgRW{@٦[xIc0Yԓ_ џ_ [&G/jVhv28$cnr=q@`Q_:hhؐfҪ/8K27=x럳"GmMRx_ss*{p҂sӮ>򢣴99Y9ȩ('/دFԮ,?x9 F }dYv-?WWRi;!-,m;_#O2^x4wW6m݁؎r@uݏ%@pW~z%Ft |cskH]0Lii8^xֿj~<V?gً' şg/Zo |%oHwH]1$I5{K{ yo`UgxC__ocB7~2hMr,>-67BQ?x} ~![]O:=zQtYY@w`=v4W~ԟ_؟ xc}alu;Ŏkң,B3,%cV#Ҁ=F:ӵ5}}+~`.Gq?cZ$ntBƞ)n4%Z'|i=[G,um+Qgn-catIVR9 e|^߀ xTEeԵKKKxU1A8POttW'KE)?]7x?4]{~&zfA!I@>>?>/xFfxΖQPdob8ȯ5g~ž ƾ,ҡgط~kv#s:^(+߳׀.m[½ST.$sHI"ıf$I'5:/Yggxk}΁˩"6 >{2Sұt~1=G^:HHiu_ "Jl?#.4&K$a=V#8DUB ?%|9;_?oOo۷W4 օ/k0V_6Px QyPi+u9PQ@~~̿k%ƫ߆ m[GoeK\{QEQ^cN b ǭU_iկJ92LrV5c_ Ac?/bm]'ƒFWF3E~Q_ؿ7PŨx󺾯{XHQ729fPL~T?. Obk D?2 *+?k۳73ğeeYͳgO,cvb1q־z?b_/NOS>qiso/F|;8s~?7ze0]hWu8tS .rH88Berƾ?#tfh.' |鿵{^Hi>s%sX ~nsL^+MZg #Ěo+-b4NТIqsT/<:xBOxN 뚜:}8쌓_[?b:1NU/ODf"qh6ZoD`h4g'3Hu=OiHUG?þ,͛KK=Nipϴt.{W%W~;[CxKQiho>Km\@sK|s>?|oya] EӍ i~۽x/)U?RW|_OZν"O $҆4je_F(((((/VG5{OWD)u;GFܮV :@Oâ>Cnc{ Jr 'Wھ7?/7cW]=JZom-mb( 'I=[,=@~0` ?/+,=\/wW"O/xO[kz֡ 2+Rg`#}wo}?2D/FH>q㌚ko6+{˺hh_|# ڞŅjvf%X, PX_?NO&ğ*Gۏ? B۱e/'kig@3wlIqڈg V?~m,<K%x.R=|ywvy_ ֿ~%j_AxJ+am`дW>qv@@vgx9}+ 6 x npC wtc3M/4=|>#{*evHH]_ڥ~t^<[A_ڤ^=5sopڵ80Lvs@?gsĖ.?eu Ks+76fq Yf8Gb?J-^,_wϙ7,os[+HfjO>OZOb賈:ڡyXarͷkL:[/m{%K#H#GѿOo&z*,ofoaḷu9ᑁ 3@u4B/=<=-jLc{Ԃ0Lܲ.Ny[7#Լ5xlJt1wz8 SPds̱pv\+s tD+CPL|+Pgsã 3*gcpߋ"~n i~H-CY:+<VP3Ҿ{?Z}'it,Ȓ VB;qm~?%Qh 𧊬P@OTG\2:)@7 %[ >R'}jc3$"+{d+b 0[dC~cH~i sǗi~/-so'GʌNHkg-CB#|/ԤkEA]k#INt{ o=,p |Es[3l&D'O%8Gk| ' 7¶TGWӵbv'>+?ॿ .|t~ܺ<;xĒo5hZz1Po` Yv'>?2n·(RS>jo"Y8.ZHPaA95^Z𭮛e iM]QZPdL1F /u@8T?XoTG6nv # ? -g IMuoo2&h#k2yw#._w} h>H1ClQL?ПCn}j?nsUύ5oR}>/2S'gqJ/J`sGXfRM{37E6=寅.xݮN=?!_ >-࿈XwC=Yks{j3X\DIU$gҀ?+c} -GQ EZr;֯X,#2^ EZs %|U+xMu=sZ}[ۙpAWcª$&/o? _{;g&֛EV˭ *mtezX e%pNG.ڧu*Eb6 pG ^w>j)\G{4YiLFvu;$A覸elڻ½amx]Me (@5?Gcπo  ¾K;;xoVyHwǓ@/5;e b?~'[4ie8|Pxź'n{l6/$pB+sBxvyz,I/qdd#y?h?dOO|GcI} dh󴲂`pq^~_rwL,>+.L_`}! 86)3h Chw~ZkxƞE&,d-IR%uX:Aě3#UٶωzqjE8=7:@:G^+@o XNh={<` Y7>!|?~*ňH#\φ;((pH4Pd:o5iWgUߵ_g7%ZRsaO5ct j*( >?1> ~>^ھnn AEm/_:~_kkجGoWOӒq-)xQ u4b~|Y*>xOڕ4LZl8$r:<{A2/ ~ѲA'߉bk"OA*r V*y+ ףZ}u^8XH( sčLAM 1m:VX)M}i_d^u?Ny|cmsXI$EvE;+\5)pԿSc_@U?gok:ƾ6.SJlh((((sxY,|tke9һ\+Tg.BW?^7Y koVѴǟlJkO<[[$/P('į=MgWH( . .S?J_xKˋɾšhvD}]*<<y?h=r?Ja" /.Qؾ=gSWCκ/fVRK0xoaMFưkid$[ 3BiXZG 8P~Z/'mwŭVCL.p>ꛈm]Ls? $ ζ#G{ [XX}HBW~5>_#h'=uko[I:?b x9KGfev1c *cj+JWA@0?z7?J;?WS|dNӾ@CpRJG1m <庒!_ҝZ7WkXdzTS(nf| ET?-k]E=}A:T~"SY 76u8(<1J`G_W:$B+ GP _7igi:ɴyγ|$?Š2qTn٢7&|/>"`-[,3 1 jE4/^ RŞn5 [ F\E?zH'HrRG +kڋ⿉:c|5bIpb8"JcE&uVןZϏjѴKۣbZ0>1i%tX X2/0~Q8[oC㎫MО8ǎz,R\S`M_g{ }mZ[]C爦DQnknJH2$'I(iM}_Η+~6Ϛ.aJ~)5KdqODeKk~\o?24Nxbq㜊h$>&ob+_RX rODF:t?ɝOFuW #l#K7}E~9g,->{gZEz-:@YP_t߷N/^ ɾ#E4kUu\dW(@ zN? M/IOhmlG 4hҚͿhry$n!|cz=ԌAGA_((qH5:((yb_3AQ,/ǀu7!YSp3޽yb3b& ݪ22Tf }?@*o гC ¿,5Q@*o гCG_t򄯀 ӝ~cڄ|DmZF6ewO ?"N?BW?^5ֿfKψϊ6\/Ï\zF?ZQʼn_=FzW?R|#w[ksY4{`!vsڿ 'n|3mo-'[&%գf+ J2rW_oi^%5 x]7SD 0pC#*@5ie;/ kv\Xa~XW%#r $iRo?&7e7񅷇Klcss }Ӝc??gwmilAa]!H‡?_):WƯ,,M?uc8"ar s_/?zdž.|ou5jx;1K>LbKgjut!V#(5 kjMZnm'hfUԂ5c6ſ=ⷋuK}N[]!Mťf1!ݣeRq ~_F]i,s-+^*4um2}dh+HclT濋+#lb;c@vYxB4ۨ/JqduaVR#5 77oO O8Ϫy'}<`F19<_I)pS}@>r]@Ҭ8qp=`?xO*O?}_jĚ.=5MaG@2 GB|jw9y ";Bp^mqܼ:~4hCؗp*p`br|bYY4ώw4=\>.7P6aY45W,~ା6<'ymxg-4w1Ea'eU!?Qo55X!M#tI-cڑd1] eQEc};+\5)pԿSc^ڗr vcx)pԿSc@Q@Q@Q@Q@\9 uG]ù/ϫh\i7: #s|kʿK7xW.Iu{/5!byVQ6(@N2ry8\a?!yS8?ioiŸ5[{ԴY+$Ln1+tQ+ꯀ?Oo^~ <_ 5]`<2xt彈n :yK.@ 3_ɇ o Ⅿm<'.bt=2[I GIa kGOxMtZU+"y2șRFQb+?:?G7KxWⷂҥG5({RC$-#ta+8n?ฟ?%x{Ⅿm<'j6GC%$6^i2{9y\a?!yb$VnKDfԵBWmĪnr|PguӮ5'J.[x9i$p9$NJ?ſ؇c_CMm:oÜ6t-~O@/xjkVj yp$k"\B @Io9nMc? UF{-x&7 |_]|a e__~.ؾ*֮0xۂxu#ھϠ_==nUƟc5֋'԰uK=pdQՆÿ|[Ś&O kiZDQ`UCzbGǿO7ARO>dD0ȅ%x7H# )VUaQ=7E_ _̛[QM#Ktу𢡊j:~ǿ*/E<= Kv-W8F3 b/48EyxiXI'2YVOLcߍX[>+xWTִ{kne$VۘQG u)~(|DAėVsh־T U0w`ws_ R~Z7=v 3uƏkc$9!eUY_iݒ Oo^~ iWIw \x [}CsOUmV ,{Nel9N_oW"A^ʺ5lxBI< -Qc]C[7(HU:]ǩ$䟓o?*Ǐ)Nk?_kn!E;*ŎF䶈*4<&7c53+M5uƽ*r_hXnewp|^9߱ǚ_Pf-D(*cj:~ῂ:Eڶi"1.}anKRw>N~|3:Hlatu (**߇=KC=3MX-m-!X`FU @OS=~ʶkq’|;6s_'͟u_$xe,$k}gN[،<.< d!qN!qN?/?*⟇m<o iSZu <˩20vE_/_Foٳ OP߆TҤ.? 56IefKx[pPf A@tg[X|#~-|1d>+9{K*7\I ,K*cZ_GZg(ngXYpy4NrHHY̯P~xC׼ -cG]K2I9φxG𾭭j ?%/r7A-iJs.T2L|h?_د{^ 0u {ڍƫ]ћiej^]pއYLC) >(ߎO}GøtIkXiȺţS+;kno7 Wn.ᾒBtco2Xl1Px>!o[{ KY KHRI6ɖd6ॿo_ ƽhSxzu[KqopU$kHr??:?:3?*?Ŀ*N|TtkQXi |HKnq+B_%ztxVkiSJF Bd^@?Z9oM~&|"%y+/쿰Oqv~ӥYɽ(s濳ڏ+'_ω>IoKRXOo_% 1ʃ;rrI'Oo^~ 4?OC[Wl~? }tY04qpy >H~_k-kk NM+"7ȎѿOj IaaU!]YʳkԆS|A}@_W !C I0}t`Ȏ/R ?Y mq.־?uKt42av3m ~&|-Ɵ_wUʼ5k(-.o^G<7fk?¾, d<5 cvr'D9ځT``@?8/o\hv~%V93/`w}-!~|S^0>*[z6x7Eom\ēv$NI lI S#WaCkn?M-} 'G>xakN3^LpvA|u &Y$Լo95x h3d "#H:5\ɱ`#WDӝ~?⯄y5bFᕑH=]4- !$E +QUZ7G'p@ 83_K _rkVI>οCW?f죩Fx㎜4v'̰s@P/;gV/;߄~w:m̷ڵd.\"Į R 89ɟI%O*/xG:}ln#^%4+=yFָuȊ.K$WeUo/Im+g |߂^go[ ݎLfadajqKy$/߆;ڥX݂ۧcXA쪠~N 㧀A ,v?i5OWxdtO mV]kNoaѬ:,h#88Яm? @@l?(?f81@>1xWPWx}t-BR4NYڧ<Ooφ,i3Zyl6V}sC'WE/ٗ rO"g-V6Ҳ3us,|hsp9::?k$7tm{឵k-2\\[A\1^2@1ωuO4ˍ?TncKm4l9! W_o!8%ǂu_Z=Ԏ ĄٙdBO'ˍry9<O?Ogß,!u;e:9/F_W¿< xGKax  Z7R@ȯ/O<@Mdl,|Ch2>Bg]cL~F~۟tOOwx7sk?O K,V/rp$N;|sLՔo> ro|7i0KrںV8 ʴk.>SgO=TC[xWO_ڰ'_(b3+߳gK➟o_ 06GZAiUsM2Eė6⥎\]ߍJ:Iur'cd0lK_7) \>o_|9⧎{7}7wbg! o,6qOo^~ ? 5e/+Y?hIE 2om3S**|3𝄺u$$co,mW;|@a~Gx|=?ggљu7&xDĸ;x!qN!qN ?)o_*I⟈_aݾ.d+ >K+!/Ld^?~_ 5!5Y5?;Cͼay|˩ef;xWh`f@$QEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEVյ=Ů*p2@mk^!kW:}𶐢[yVT$DRE~ҞЫjvj\ܤ%8Fqֿytm~vhm/mYSp287w_9_ӧ}SQ~t< $)IzI(((((((((((((^ 6866666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p(8HX`~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH R@R Z Heading 1dd@&[$\$5CJ0KH$\aJ0DA`D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List B^@B Z Normal (Web)dd[$\$.X@. ZEmphasis6]*W@* ZStrong5\4"4 ZHeader  !4 @24 ZFooter  !.)@A. Z Page Numberf\@fZ z-Top of Form$&dPa$<CJOJQJ^JaJl]@lZz-Bottom of Form$$dNa$<CJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 33J 1<[[[^Z g r S3 # 3 Z ~  | O s YC3  !"$DTl|Vfiy\ly3G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$18AHJ^!!@  @H 0(  >(  P   "?   ^0e0e.@`T`T`T`T#"  ? B S  ?@C3N{ t^ 6 Check1Check2Check3Check4Check5Check6Check7Check8Check9Check10Check11Check12Check18Check13Check17Check14Check16Check15DlVi\y4 U}gzm4EEGHHJKMNPQtv~14EGHJKMNPQ!143DEQt4hj$^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(hjxxc aIvV CzM CC PP)vCo!Cg }kCo7Cfc?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F#\ʕData &{\1Table.'WordDocument4JSummaryInformation(DocumentSummaryInformation8Macros UDʕUDʕVBA UDʕUDʕdirThisDocument _VBA_PROJECT PROJECT H  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGIJKLMNPS     0* pHdProjectQ(@= l gN J< rstdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\Windows\system32\e2.tlb#OLE Automation`ENormalENCrmaQF  * \C aN!OfficgOficg!G{2DF8D04C-5BFA-101@B-BDE5gAjAe42ggram Files\CommonMicrosoft Shared\OFFICE11\MSO.DLL#M 11 .0 Ob Library%"xMSFAs>MSFBs3@dD452EE1-E08F0A-8-02608C@4D0BB4dFM20L'B p&/;"1D|~ C00}#0B# 50 A240B3@a-0E48-4271-9B8D-28D524@5B1D786Users\Jerry\AppData\Local\Temp\Wo`rd8.0@c7.xexdHd<".E .`M "BThisDocumentG Tis"Dlcu@en 2 ` (H1"yX",T""+ay  *\G{000204EF-0000-0000-C000-000000000046}#4.0#9#C:\Program Files\Common Files\Microsoft Shared\VBA\VBA6\VBE6.D;i[,8nOv͚֦!%hD{kf64jNCA}x+DefaultOcxName36, 25, 19, MSForms, HTMLText+DefaultOcxName35, 24, 20, MSForms, HTMLText+DefaultOcxName34, 23, 21, MSForms, HTMLText+DefaultOcxName33, 22, 22, MSForms, HTMLText+DefaultOcxName32, 21, 23, MSForms, HTMLText+DefaultOcxName31, 20, 24, MSForms, HTMLText+DefaultOcxName30, 19, 25, MSForms, HTMLText+DefaultOcxName29, 18, 26, MSForms, HTMLText+DefaultOcxName28, 17, 27, MSForms, HTMLText+DefaultOcxName27, 16, 28, MSForms, HTMLText+DefaultOcxName26, 15, 29, MSForms, HTMLText+DefaultOcxName25, 14, 30, MSForms, HTMLText+DefaultOcxName22, 13, 31, MSForms, HTMLText+DefaultOcxName21, 12, 32, MSForms, HTMLText+DefaultOcxName18, 11, 33, MSForms, HTMLText+DefaultOcxName17, 10, 34, MSForms, HTMLText*DefaultOcxName14, 9, 35, MSForms, HTMLText*DefaultOcxName13, 8, 36, MSForms, HTMLText*DefaultOcxName12, 7, 37, MSForms, HTMLText*DefaultOcxName11, 6, 38, MSForms, HTMLText*DefaultOcxName10, 5, 39, MSForms, HTMLText)DefaultOcxName9, 4, 40, MSForms, HTMLText)DefaultOcxName8, 3, 41, MSForms, HTMLText)DefaultOcxName7, 2, 42, MSForms, HTMLText)DefaultOcxName6, 1, 43, MSForms, HTMLText)DefaultOcxName5, 0, 44, MSForms, HTMLTextME PS"SS"<<s<<(1Normal.ThisDocument (%%*mh0,%*k`+%*i*%*g)%*e((%*cX '%*aP&%*_%%*]$%*[#%*UH"%*Sx@!%*Mp %*K%*E%*C8%*Ah0%*?`%*=%*;%*9(%*7X %*5P%*3%*1%*/H8h(X8h0H p@(*Y (@*[ 4@*] <@*_ D0@ *a L`@!*c T@"*e \@#*g d@$*i l @%*k tP@&*m |@'H(X8xHXXh8 H @ 8 0 (     8h8 h8h8 X( `h8 (X( % %8 &*\R8005*#82xAttribute VB_Name = "ThisDocument" Bas1Normal.VGlobal!SpaclFalse CreatablPre declaIdTru BExposeTemplateDeriv$Custom izC1ControlDefa@ultOcxm36, 25, 1@9, MSFs, HTMLTeNx" 24$0k" 3"1"A2@x4A!2@xADFx@giw2@x18E@|x@17@x@1A@x@1!O 5`{_ O3,E1`E3 >1 ^3`<1 3YWB_vz<1`"3`#v334 Ea`*N3`*N3V9+*!3"?5=@+4@ ua*, 4`u)+4`uxU*40 LL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.3#0#C:\Program Files\Microsoft Office\OFFICE11\MSWORD.OLB#Microsoft Word 11.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\Windows\system32\stdole2.tlb#OLE Automation*\CNormal*\CNormalaN(*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.3#0#C:\Program Files\Common Files\Microsoft Shared\OFFICE11\MSO.DLL#Microsoft Office 11.0 Object Library*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\Windows\system32\FM20.DLL#Microsoft Forms 2.0 Object Library*\G{240B3A00-0E48-4271-9B8D-28D5245B1D78}#2.0#0#C:\Users\Jerry\AppData\Local\Temp\Word8.0\MSForms.exd#Microsoft Forms 2.0 Object Library.E .`M  gN ThisDocument5S4ec56c59ThisDocument ёwjC]h,`;<8.WordkVBAWin16~Win32MacVBA6#Project1 stdole`Project- ThisDocument< _EvaluateNormalOfficeuDocumentjMSFormsCDefaultOcxName44~.DefaultOcxName43}.DefaultOcxName42|.DefaultOcxName41{.DefaultOcxName40z.DefaultOcxName39^.DefaultOcxName38].DefaultOcxName37\.DefaultOcxName36[.DefaultOcxName35Z.DefaultOcxName34Y.DefaultOcxName33X.DefaultOcxName32W.DefaultOcxName31V.DefaultOcxName30U.DefaultOcxName299.DefaultOcxName288.DefaultOcxName277.DefaultOcxName266.DefaultOcxName255.DefaultOcxName244.DefaultOcxName233.DefaultOcxName222.DefaultOcxName211.DefaultOcxName200.DefaultOcxName19.DefaultOcxName18.DefaultOcxName17.DefaultOcxName16.DefaultOcxName15.DefaultOcxName14.DefaultOcxName13.DefaultOcxName12 .DefaultOcxName11 .DefaultOcxName10 .DefaultOcxName9+DefaultOcxName8*DefaultOcxName7)DefaultOcxName6(DefaultOcxName5'DefaultOcxName4&DefaultOcxName3%DefaultOcxName2$DefaultOcxName1#DefaultOcxName`  ID="{C805D081-F22F-4B46-89F3-5CC673EC8B56}" Document=ThisDocument/&H00000000 Name="Project" HelpContextID="0" VersionCompatible32="393222000" CMG="DEDC35E84B387E3C7E3C7E3C7E3C" DPB="0D0FE6D53A053B053B05" GC="3C3ED70629342A342ACB" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 &H00000002={000209F2-0000-0000-C000-000000000046};Word8.0;&H00000000 U\gU\g$U\gPROJECTlk ONPROJECTwmQ)CompObjRrThisDocumentThisDocument  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q