ࡱ> dUeEnter line three of address DLNAMEEnter LAST name DFNAMEEnter FIRST name DMIEnter MIDDLE INITIAL HDfGRADE"Choose GRADE from pull-down list  SEN2LT1LTCPTMAJLTCCOLGENCADc/1LTc/2LTc/CPTc/MAJc/LTCtDeCheck1tDREQUEST FOR CAP PHOTO IDENTIFICATION CARD eCheck1D CAPSNEnter 9-digit CAPSN DCHARTEREnter 5-digit CHARTER numberDDOB d-MMM*+,-./01234G$$Tl\w$-$&$$Tl0-$h$ *+,-./0123456789:;<=>?@A 456789:;<`T$$Tl4rw&-$G$$Tl\w#--yyyy/Enter DOB (any format converted to dd-mon-yyyy)Df HAIR_COLOR  BALDBLONDBLACKBROWNWHITEREDGREYSILVERDf EYE_COLOR BLKBLUHZLGRNBRN^D0 LB^D0 INDadrs1Enter line one of address Dadrs2Enter line two of address Dadrs3Enter line three of address DText1d-MMM-yyoRecovery save of Document1.asdD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP formsof address Dadrs3Enter line three of address DText1d-MMM-yyLDfGRADE SEN2LT1LTCPTMAJLTCCOLGENc/Bc/AMNc/A1Cc/SGTc/SSGc/TSGc/MSGc/1LTc/2LTc/CPTc/MAJc/LTCtDeCheck1tDeCheck1Df HAIR_COLORxz|JL`bdnprt H J ^ ` b l n p r vjCJUjRCJUjCJOJQJUmHjCJUjCJUjCJUmHjPCJUCJ jCJUj 5CJUj 5CJU5CJ CJOJQJj5CJUj 5CJU.NAME (Last, First, Middle Initial)  FORMTEXT        FORMTEXT        FORMTEXT  GRADE  FORMDROPDOWN CADET  FORMCHECKBOX  SENIOR  FORMCHECKBOX  PHOTOCAPSN  FORMTEXT      UNIT NO.  FORMTEXT      DATE OF BIRTH day month year  FORMTEXT       1" x 1"COLOR HAIR  FORMDROPDOWN COLOR EYES  FORMDROPDOWN WEIGHT  FORMTEXT      HEIGHT  FORMTEXT      MEMBER'S ADDRESS (Number, Street, State, Zip Code)  FORMTEXT        FORMTEXT        FORMTEXT      SIGNATURE OF MEMBERDATE  FORMTEXT      CAP 19a FORM MAY 81 !!!!"!$!@!B!D!\!^!r!t!v!!!!!!!!!!!! " """""*"ƿƿƿ~ CJOJQJjCJUjCJUjJCJUjCJOJQJUjbCJOJQJU CJOJQJjCJOJQJUjCJU CJOJQJjCJUCJjCJUmH jCJU1*"@"B"^"`"b"x"z""""""""""""""""##h#j#~###################$$$$j"CJUjxCJUjCJUmHjCJUCJ jCJUjp5CJUj5CJUmHj5CJUj`5CJUjz5CJU5CJj5CJU CJOJQJ0"h###$F$R$`$b$d$f$$( ($$ $$&$($2$4$6$F$H$`$d$f$@CJ OJQJjOJQJUmHjCJUmH jCJUjCJU <=>?@Ad0lFN ($ . $ ($($$$Tl-$$$Tl-ln(*jFH\^`jlnp{jCJUjVCJUjCJUjCJUmHj(CJUCJ jCJUjFCJOJQJUjCJOJQJUjCJOJQJUmHjCJOJQJU CJOJQJjCJOJQJU0NAME (Last, First, Middle Initial)  FORMTEXT        FORMTEXT        FORMTEXT  GRADE  FORMDROPDOWN CADET  FORMCHECKBOX  SENIOR  FORMCHECKBOX CAPSN  FORMTEXT      UNIT NO.  FORMTEXT      DATE OF BIRTH day month year  FORMTEXT      COLOR HAIR  FORMDROPDOWN COLOR EYES  FORMDROPDOWN WEIGHT  FORMTEXT      HEIGHT  FORMTEXT      MEMBER'S ADDRESS (Number, Street, State, Zip Code)  FORMTEXT        FORMTEXT        FORMTEXT      SIGNATURE OF MEMBERDATE  ">@BNPdfhrt  "$@BDZ\xؿرؿؖؿ؈{o{jP 5CJU5CJj5CJUjn CJOJQJUj CJOJQJUjCJOJQJUmHj CJOJQJUjCJOJQJUj CJOJQJU CJOJQJj8 CJOJQJU CJOJQJjCJOJQJU'  BALDBLONDBLACKBROWNWHITEREDGREYSILVERDf EYE_COLOR BLKBLUHZLGRNBRN$($ ($ .Oh+'0 4@ \ h t*REQUEST FOR CAP PHOTO IDENTIFICATION CARDrdEQUD. Charles Kowalewski, D.O.. CCapf19aD. Charles Kowalewski, D.O.5 CMicrosoft Word 8.0k@,@G@2򅲽X [4@4NormalCJOJQJkHmH <A@<Default Paragraph Font8,:167:lx 4<AUnknownD. Charles Kowalewski, D.O.Dr. Chuck KowalewskiO[acouw&28GWdt}8FFFS G$G$FFFS$S$FFFFF LNAMEFNAMEMIGRADECheck1CAPSNCHARTERDOB HAIR_COLOR EYE_COLORadrs1adrs2adrs3Pdx'He : bv9Xu::: D. Charles Kowalewski, D.O.*C:\TEMP\AutoRecovery save of Document1.asdD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.(C:\TEMP\AutoRecovery save of CAPF19A.asdD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dot@ v- (OJQJ(5CJOJQJx((.(5OJQJ,NOPQYZ[\abcdemnopuvwxy  &'(012389:<FGXYcduv|}  015678P@QPDQFQHQJQZQ\Q^Q`QjQlQnQpQrQQQQQQQQQQQQQQPX@QPQQQQQQPZ@QQQQQQ Q QPQQQ Q"Q$Q<Q>Q@P\@P^@QBPLQNQPQRQbQdQfQhQrPb@PtQQQQQQQQPd@PQQQQPQQQQQQQQ Pf@ Ph@Q P Q"Pl@ QDPXQZPn@Q|PQPp@QPQPr@Pt@PQJQLQNQ^Q`QbQdQnPpQrQtQvQQQQQPQQQQQQQQPv@QPz@QP|@P~@P@GTimes New Roman5Symbol3& Arial"hc&&R"r0d>)REQUEST FOR CAP PHOTO IDENTIFICATION CARDD. Charles Kowalewski, D.O.D. Charles Kowalewski, D.O.՜.+,D՜.+,T hp|   Sl *REQUEST FOR CAP PHOTO IDENTIFICATION CARD Title 6> _PID_GUIDAN{44A4E203-023B-11D1-80A5-00403391F2F7}$$&$($2$4$6$F$H$`$d$f$..4.6.8.:.<.Z.\.^.r...ǽɯ啉~j5CJUmHjn5CJUj5CJUjCJOJQJUjCJOJQJUjT5U5 j5U@CJ OJQJjOJQJUmHjCJUmH jCJUjCJU            FORMDROPDOWN                                              "h###$F$R$`$b$d$f$.$( ($$ QUEST FOR CAP PHOTO IDENTIFICATION CARDD. Charles Kowalewski, D.O.D. Charles Kowalewski, D.O. [4@4NormalCJOJQJkHmH <A@<Default Paragraph Font t t+-P-ABCKVhs+,@YZcejqulx *"$$. 4<".AUnknownD. Cha*+/045:;<=?Adfz|~ *,.0>@\^`l𪣕𪣇jCJOJQJUjCJOJQJU CJOJQJjCJOJQJUjCJUj.CJUjCJUjCJUmHjCJUCJ jCJU CJOJQJ5CJOJQJ2/ =!"=#$=%NAME (Last, First, Middle Initial)  FORMTEXT        FORMTEXT        FORMTEXT  GRADE  FORMDROPDOWN CADET  FORMCHECKBOX  SENIOR  FORMCHECKBOX CAPSN  FORMTEXT      UNIT NO.  FORMTEXT      DATE OF BIRTH day month year  FORMTEXT      COLOR HAIRCOLOR EYESWEIGHTHEIGHT"ZJrH !F!\!!!!"@"x""" ^$ ^($w($ $ x($$($ ($ . [4@4NormalCJOJQJkHmH <A@<Default Paragraph Font t t+-P-ABCKVhs+,@YZcejqurles Kowalewski, D.O.Dr. Chuck KowalewskiP\bdpvx-9?Vfs#)EQWtFFFS G$G$FFFS$S$FFFFFF8@|(  DLNAMEEnter LAST name DFNAMEEnter FIRST name DMIEnter MIDDLE INITIAL HDfGRADE"Choose GRADE from pull-down list  SEN2LT1LTCPTMAJLTCCOLGENCADc/1LTc/2LTc/CPTc/MAJc/LTCtDeCheck1tDeCheck1D CAPSNEnter 9-digit CAPSN DCHARTEREnter 5-digit CHARTER numberDDOB d-MMM-yyyy/Enter DOB (any format converted to dd-mon-yyyy)DLNAMEEnter LAST name DFNAMEEnter FIRST name DMIEnter MIDDLE INITIAL HDfGRADE"Choose GRADE from pull-down list  SEN2LT1LTCPTMAJLTCCOLGENCADc/1LTc/2LTc/CPTc/MAJc/LTCtDeCheck1tDeCheck1D CAPSNEnter 9-digit CAPSN DCHARTEREnter 5-digit CHARTER numberDDOB d-MMM-yyyy/Enter DOB (any format converted to dd-mon-yyyy)Df HAIR_COLORD "(.48= BALDBLONDBLACKBROWNWHITEREDGREYSILVERDf EYE_COLOR% ! BLKBLUHZLGRNBRN^D0 LB^Dlx *"$$f$ 4<"f$AUnknownD. Charles Kowalewski, D.O.Dr. Chuck KowalewskiP\bdpvx-9?Vfs#)EQWtFFFS$G$G$FFFS$S$FFFFFF8@|(  6   N  3  NB  S DB S  ?+Zct.Pt`j .jLNAMEFNAMEMIGRADECheck1CAPSNCHARTERDOB HAIR_COLOR EYE_COLORadrs1adrs2adrs3Text1Qey.WtFu cw@g*Xueueu D. Charles Kowalewski, D.O.*C:\TEMP\AutoRecovery save of Document1.asdD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.(C:\TEMP\AutoRecovery save of CAPF19A.asdD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dot@RW vRR-x(OJQJx(5CJOJQJx$Rw(OJQJ^(.OJQJ$CJOJQJx(5OJQJ((OJQJ(OJQJ0+,-OPQRZ[\]bcdefnopqvwxyz !"',-./789:?@ABCJKUVefghrs !"#$)*+,?@DEFGOPQRWXYZ[^bdeipqrstP@Q PV@Q PF QH QJ QL Q\ Q^ Q` Qb Ql Qn Qp Qr Qt Q Q Q Q Q Q Q Q Q Q Q Q Q Q PX@Q P Q Q Q Q Q Q PZ@Q Q Q Q Q Q !Q!Q!P!Q!Q !Q"!Q$!Q&!Q>!Q@!QB!P\@P^@PD!QF!P`@QP!PZ!Q\!Q^!Q`!Qp!Qr!Qt!Qv!Q!Pb@ P!Q!Q!Q!Q!Q!Q!Q!AUnknownD. Charles Kowalewski, D.O.Dr. Chuck KowalewskiO[acouw&28gFFFS G$G$FFFLNAMEFNAMEMIGRADECheck1CAPSNCHARTERDOBPdx'ibv9iiiD. Charles Kowalewski, D.O.*C:\TEMP\AutoRecovery save of Document1.asdD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.(C:\TEMP\AutoRecovery save of CAPF19A.asdD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dot@&9 v(&&w (OJQJ(5CJOJQJx((.,NOPQYZ[\abcdemnopuvwxy  &'(012389:<FGQRXY_`fgP@QPbQdQfQhQxQzQ|Q~QQQQQQQQQQQQQQQQQQQPX@QPQQQQQQPZ@QQ Q QQQ(Q*Q,P.Q0Q<Q>Q@QBQZQ\Q^P\@P^@Q`PjQlQnQpQQQQQPb@PQQQQQQQQPd@PQQQQPQQQQQQQQ(Pf@ Ph@Q*Pl@Q>Pn@QRPp@Q^Pr@Pt@P@GTimes New Roman5Symbol3& Arial"hc&y&3("r0dk)REQUEST FOR CAP PHOTO IDENTIFICATION CARDD. Charles Kowalewski, D.O.D. Charles Kowalewski, D.O.DLNAMEEnter LAST name DQ!Pd@ Q!P!Q!Q!Q!Q!Q!P!Q!Q!Q!Q"Q "Q "Q"Q"Pf@ Ph@P"Q"Pj@ Q*"P>"Q@"Q^"Q`"Pl@Qb"Pv"Qx"Q"Q"Pn@Q"P"Q"Q"Q"Pp@Q"P"Q"Q"Q#Pr@Pt@Q#Pf#Qh#Qj#Ql#Q|#Q~#Q#Q#Q#P#Q#Q#Q#Q#Q#Q#Q#Q#P#Q#Q#Q#Q#Q#Q#Q#Q#Pv@Px@Q#Pz@Q$P $Q$Q$Q$Q"$Q$$Q&$Q($Q2$P|@P~@Q4$Q6$Q<$PD$P@QH$PP$P^$P`$Pb$P@GTimes New Roman5Symbol3& Arial"hc&& X$"r0dl)REQUEST 0 INDadrs1Enter line one of address Dadrs2Enter line two of address Dadrs36   N  3  NB  S DB S  ?+Zct.Pt`j .jLNAMEFNAMEMIGRADECheck1CAPSNCHARTERDOB HAIR_COLOR EYE_COLORadrs1adrs2adrs3Text1Qey.WtFu cw@g*XueueuD. Charles Kowalewski, D.O.*C:\TEMP\AutoRecovery save of Document1.asdD. Charles Kowalewski, D.O.&D:\Users\drcFOR CAP PHOTO IDENTIFICATION CARDD. Charles Kowalewski, D.O.D. Charles Kowalewski, D.O.G =Abjbjَ .e]<,:|s t <y { { { { { { $ # Y^# # C xC C C # 8y # y C 6C y y  0{L3 y Root Entry F˥I0{LV@1TableWordDocumentP.SummaryInformation( , -/ !"#$. 9345678L:;<=>?@AICDEFGHJKOQTWXBDocumentSummaryInformation8CompObjjData 2T0Table0   FMicrosoft Word Document MSWordDocWord.Document.89q՜.+,D՜.+,T hp|   Sl  *REQUEST FOR CAP PHOTO IDENTIFICATION CARD Title 6> _PID_GUIDAN{44A4E203-023B-11D1-80A5-00403391F2F7}Oh+'0 4@ \ h t*REQUEST FOR CAP PHOTO IDENTIFICATION CARDrdEQUD. Charles Kowalewski, D.O.. CCapf19aD. Charles Kowalewski, D.O.4 CMicrosoft Word 8.0k@hx@G@txLX [4@4NormalCJOJQJkHmH <A@<Default Paragraph Fontg,:ilj 4<huck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.(C:\TEMP\AutoRecovery save of CAPF19A.asdD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.&D:\Users\drchuck\CAP forms\CAPF19A.dotD. Charles Kowalewski, D.O.7D:\Users\drchuck\My Documents\CAP\Cap Forms\CAPF19A.dot@ hx(OJQJx(5CJOJQJx$Rw(OJQJ^(.OJQJ$CJOJQJx(5OJQJ((OJQJ(OJQJ0+,-OPQRZ[\]bcdefnopqvwxyz !"',-./789:?@ABCJKUVefghrs !"#$)*+,?@DEFGOPQRWXYZ[^bdeipqrst0@1 0V@1 0F 1H 1J 1L 1\ 1^ 1` 1.1l 1n 1p 1r 1t 1 1 1 1 .1 1 1 1 1 1 1 1 1.1 0X@1 0 1.1.1.12.14.16.0Z@1 1 1 1 1 1 !18.1!0!1!1 !1"!1$!1&!1>!1:.1B!0\@0^@0D!1F!0`@1P!0Z!1\!1^!1`!1p!1r!1t!1<.1!0b@ 0!1!1!1!1!1!1!1F.1!0d@ 1!0!1!1!1!1!1!0!1!1!1!1"1 "1 "1P.1"0f@ 0h@0"1"0j@ 1*"0>"1@"1Z.1`"0l@1b"0v"1x"1\.1"0n@1"0"1"1^.1"0p@1"0"1"1h.1#0r@0t@1#0f#1h#1j#1l#1|#1~#1#1r.1#0#1#1#1#1#1#1#1|.1#0#1#1#1#1#1#1#1.1#0v@0x@1#0z@1$0 $1$1$1$1"$1$$1&$1.12$0|@0~@14$16$1<$0D$0@1H$0P$0^$0`$0b$0@GTimes New Roman5Symbol3& Arial"hc&'!X$"r0dl)REQUEST FOR CAP PHOTO IDENTIFICATION CARDD. Charles Kowalewski, D.O.D. Charles Kowalewski, D.O.G MAbjbjَ 0=e]zzhhhh<,*TllllKt<  $p+d-! 1^!zzllxz8ll zzzz   l P hh  Root Entry F˥IP hh@1TableL.WordDocumentb0SummaryInformation( ,  (-/ !"#)'&*+1. 9M345678L:;<=>?@AICDEFGHJKONYZ[\]^_`acigBf_PID_GUIDAN{44A4E203-023B-11D1-80A5-00403391F2F7}Oh+'0 4@ \ h t*REQUEST FOR CAP PHOTO IDENTIFICATION CARDrdEQUD. Charles Kowalewski, D.O.. CCapf19aD. Charles Kowalewski, D.O.5 CMicrosoft Word 8.0k@,@G@2򅲽X [4@4NormalCJOJQJkHmH <A@<Default Paragraph Fontg,:ilj 4<  FMicrosoft Word Document MSWordDocWord.Document.89q՜.+,D՜.+,T hp|   Sl *REQUEST FOR CAP PHOTO IDENTIFICATION CARD Title 6> DocumentSummaryInformation8CompObjjData 2 0Table0