ࡱ> .0+,-{ bjbjzz 0j  PPPddd8,d80)!!\"07777777$:k=7P9& @)!9&9&7U8)))9&d8P7)9&7))384pc$&R4v7k8084^'>&'>,4'>P4|M"]#)$$~M"M"M"77(M"M"M"89&9&9&9&'>M"M"M"M"M"M"M"M"M" :   SHAPE \* MERGEFORMAT  Department of Public Health Womens & Childrens Health Section 1914 Mail Service Center, Raleigh, North Carolina 27699-1914 Tel 919-707-5800 ( Fax 919-870-4863USER ID SERVICE REQUEST for WIC ACCESS in HSIS Employee InformationComplete this section entirely for all requests. Please print or type.01. Employee Name:  FORMTEXT      02. Position:  FORMTEXT      03. Program Code:  FORMTEXT      04. Site No:  FORMTEXT      05. Bill Code:  FORMTEXT      -NER06. County Code:  FORMTEXT      07. Agency Name:  FORMTEXT      08. County Name:  FORMTEXT      09. Street Address:  FORMTEXT      10. City:  FORMTEXT       , NC11. Zip:  FORMTEXT      12. Email Address:  FORMTEXT      13. Main WIC Phone Number: (  FORMTEXT     )  FORMTEXT      14. WIC Fax number: (  FORMTEXT     )  FORMTEXT       Request New User ID 15.  FORMCHECKBOX  Full WIC Access 16.  FORMCHECKBOX  View Only WIC Access 17.  FORMCHECKBOX  XNET Access 18.  FORMCHECKBOX  Other (Explain):  FORMTEXT       Please complete the following information, if known, for New User ID and Transfer User ID Requests: 19. Remote Terminal ID:  FORMTEXT       20. Voucher Station Number:  FORMTEXT       21. Report Printer Node:  FORMTEXT       22. MICR Printer Node:  FORMTEXT        Change Existing User ID 23. **Enter Current User ID:  FORMTEXT       ** (Required for All User ID Change Requests) 24. WIC Access Level Change 24a.  FORMCHECKBOX  Request Full Access 24b.  FORMCHECKBOX  Request View Only Access 24c.  FORMCHECKBOX  Remove WIC access from Non-WIC User ID 24d. Request  FORMCHECKBOX  Read  FORMCHECKBOX  Write  FORMCHECKBOX  Delete Access to Specific Screen #  FORMTEXT       24e.  FORMCHECKBOX  Remove Access from Screen #  FORMTEXT       25.  FORMCHECKBOX  Terminate WIC User ID Effective Date:  FORMTEXT       26. Other 26a.  FORMCHECKBOX  (Explain)  FORMTEXT       26b.  FORMCHECKBOX  Change/Correct User Name:  FORMTEXT       26c.  FORMCHECKBOX  Add XNET Access 26d.  FORMCHECKBOX  Remove XNET Access 27. Transfer User ID (Fill out all below as well as #18 - #21) 27a. Old End date:  FORMTEXT       27b. Old Agency Name:  FORMTEXT       27c. New Start date:  FORMTEXT       27d. New Agency Name:  FORMTEXT       (For NSB Helpdesk Use Only) RACF ID # Date Completed: Initials:  FORMCHECKBOX  NCTE  FORMCHECKBOX  PW  FORMCHECKBOX  HSIS  FORMCHECKBOX  XLS  FORMCHECKBOX  XNET Access  FORMCHECKBOX  File Snapshot  FORMCHECKBOX  IRM  FORMCHECKBOX  Created Notification Letter  FORMCHECKBOX  Faxed/Emailed WIC Director  FORMCHECKBOX  Remedy Ticket _________________  AuthorizationI am the WIC director for this program/site and I authorize the requested User ID service.28. Signature of WIC Director29. Print Name of WIC Director30. Date Signed:  FORMTEXT      31. Phone Number: (  FORMTEXT     )  FORMTEXT      Do not sign this form before it has been completed. Please complete a Confidentiality Agreement form for New User ID, Transfer User ID or Name Change requests only. Fax all completed,"#$%(i񴞋ub[ODhih@<CJaJhhr#U5CJaJ hvhr#U%hh/6CJOJQJ\]aJ+ jhhr#U6CJOJQJ\]aJ%hhr#U6CJOJQJ\]aJ+hhr#U56CJOJQJ\]aJh%hhr#U6CJOJQJ]aJhjhr#UUhfrjRhHUjhr#UUmHnHujhr#UUhr#Uhhr#UCJaJ#$&  $Ifgd$  $Ifa$gdIkd$IfK$L$lm t644 lap yt$  $Ifa$gdK$&'(Eiwggggw$$Ifa$gd  $Ifgdykd)$$Ifl4Fl*`` t*6    44 lapytuu  $Ifgd{kd$$Ifl4Fl*   t*6    44 lapyt $Ifgd+ZckdE$$Ifl40l* # t*644 lapyt   * 2 7 : [ \ ] ` a o p q { |    ( * , @ nXLhh+ZCJ\aJ+jhh+ZCJU\aJmHnHu&jhh+ZCJU\aJ jhh+ZCJU\aJhh+ZCJ\aJhh+ZCJ\aJhh+ZCJaJhh+ZCJaJ h h+Zhh+Z6hh+Z56>*\hh+Z56\hhh856\h+Zhh+ZaJ  \ y $$Ifa$gdykd$$Ifl=*+  t 0644 lap yt\ ]  R $Ifgd+ZpkdV$$Ifl*+ t0644 lap yt@ B D N P R T \ x z ۺuaUIIhh+ZCJ\aJhh+ZCJ\aJ'jhh+ZCJU\mHnHu"jnhh+ZCJU\hh+ZCJ\jhh+ZCJU\hh+ZCJaJhh+ZCJaJh+Zhh+ZCJaJ+jhh+ZCJU\aJmHnHu jhh+ZCJU\aJ&jVhh+ZCJU\aJR T 4 vmmmm $Ifgd+Zkdʮ$$IflZ0*\ t0644 lapyt      ( * 2 4 : < T X Z n ۺr\Qۗhh+ZCJaJ+jhh+ZCJU\aJmHnHu&jZhh+ZCJU\aJ jhh+ZCJU\aJhh+ZCJ\aJhh+ZCJ\aJhh+ZCJaJhh+ZCJaJ+jhh+ZCJU\aJmHnHu jhh+ZCJU\aJ&jhh+ZCJU\aJn p r | ~         ۺۓۺۓkۺ`Uhh{iCJaJhh{iCJaJ&jhh+ZCJU\aJ&jhh+ZCJU\aJhh+ZCJ\aJhh+ZCJ\aJhh+ZCJaJh+Zhh+ZCJaJ+jhh+ZCJU\aJmHnHu jhh+ZCJU\aJ&jаhh+ZCJU\aJ  F== $Ifgd+ZkdF$$IflZ\ H* @p L t0644 lap(yt  h vmm $Ifgd+Zkd$$IflZ0*\ t0644 lapyt . > @ B V X Z d f h n p z | ~    " , ݸ̢̗x̢thT̢&j4hh{iCJU\aJhh{iCJ\aJh{i&jhh{iCJU\aJhh{iCJaJhh{iCJaJ+jhh{iCJU\aJmHnHu&jhh{iCJU\aJ jhh{iCJU\aJhh{iCJ\aJhh{iCJ\aJhh{iCJaJ 0 ~ vmm $Ifgd+Zkd$$IflZ0*p t0644 lapyt, . 0 B J R V X l n p z | ~ د؛yuj_jTH7H jhh+ZCJU\aJhh+ZCJ\aJhh+ZCJaJhhv NCJaJhh+ZCJaJh{ihh{i5CJaJ+jhh{iCJU\aJmHnHu&jhh{iCJU\aJ jhh{iCJU\aJhhX+CJ\aJhhv NCJ\aJhh{iCJ\aJhh{iCJaJ jhh{iCJU\aJ~ vmm $Ifgd+Zkd $$IflZ0~ * ! t0644 lapyt  >@TVX^`fjl۹۹ۚ۹p۹dSd jhh+ZCJU\aJhh+ZCJ\aJ&jhh+ZCJU\aJhhv NCJaJhh+ZCJaJhh+ZCJaJ&j8hh+ZCJU\aJhh+ZCJ\aJ+jhh+ZCJU\aJmHnHu jhh+ZCJU\aJ&jĶhh+ZCJU\aJۺ{pepSE0S)jhh 5CJU\aJhh 5CJ\aJ#jhh 5CJU\aJhhv NCJaJhh CJaJhfhhfCJaJhhf5CJaJ(jhhHCJUaJmHnHuh%hfCJaJh+Zhh+ZCJaJ+jhh+ZCJU\aJmHnHu jhh+ZCJU\aJ&jhh+ZCJU\aJvqc $$Ifa$gdK$gdfkd$$IflZ0*  t0644 lapytzo $IfgdPK$kd$$IfK$L$l- :0  t 6Pp 0044 lae4p yt 68:<PXdfhjlprwbWhh CJaJ)j.hh 5CJU\aJhhf5CJaJhhfCJaJ)j hh 5CJU\aJ#jhh 5CJU\aJhhv NCJaJhh CJaJh hh CJaJhh/WCJ\aJhh CJ\aJhh 5CJ\aJfx $IfgdPK${kdZ$IfK$L$ln :0 t 6Pp0044 lae4p ytfhx $IfgdPK${kd~$IfK$L$ln :0 t 6Pp0044 lae4p yt(x $IfgdPK${kd$IfK$L$ln :0 t 6Pp0044 lae4p yt$&(*.k`\M>hh_dB56CJ]aJhhf56CJ]aJhfhhfCJaJ(jhhfCJUaJmHnHu#jƽhhfCJUaJjhhfCJUaJhhfCJaJ&jRhhfCJU\aJhhfCJ\aJ jhhfCJU\aJhhv NCJaJhhfCJaJhh 5CJaJ(*,w $IfgdPK$}kd<$IfK$L$l4_ :`0 t 6Pp0044 lae4p yt,.vh $$Ifa$gdK$ $$Ifa$gd}kd$IfK$L$l4_ :0 t 6Pp0044 lae4p yt&(*,@BŶwlaPD0&jVhhfCJU\aJhhfCJ\aJ jhhfCJU\aJhhH&CJaJhhfCJaJhhv NCJaJhhfCJaJhhfCJaJhh756CJ]aJhh8p56CJ]aJhhf56CJ]aJhh_dB5CJ]aJhhf5CJ]aJhh_dB56CJ]aJhhH&56CJ]aJRx $IfgdPK${kd$IfK$L$l_ :0 t 6Pp0044 lae4p ytBDNPRTX\ΪtΪ`\Phhf5CJaJhf&jhhfCJU\aJhh52CJaJ&j|hhfCJU\aJhhfCJ\aJhhfCJaJhhfCJaJhhv NCJaJhhf5CJ\aJhhfCJaJ+jhhfCJU\aJmHnHu jhhfCJU\aJRTx $IfgdPK${kd$IfK$L$ln :0 t 6Pp0044 lae4p ytx $IfgdPK${kd$IfK$L$ln :0 t 6Pp0044 lae4p ytnx $IfgdPK${kd$IfK$L$ln :0 t 6Pp0044 lae4p ytBFH\^`jlnprtv®ΘΔ|jXL>hhf5CJ\aJhhf5CJaJ#hhf5CJOJQJ^JaJ#hh;RY5CJOJQJ^JaJ hhfCJOJQJ^JaJ hhfhf+jhhfCJU\aJmHnHu&jhhfCJU\aJhhfCJ\aJ jhhfCJU\aJhhfCJaJhhfCJaJhhv NCJaJnprtvzzzh$ $Ifa$gdK$ $IfgdP{kd>$IfK$L$ln :0 t 6Pp0044 lae4p yt  $IfgdPK$Rkd$IfK$L$l=   t 44 lap yt  06jlnpɾɗɓugu[O[Dhh)CJaJhhv N5CJaJhhf5CJaJhh56CJaJhhf56CJaJhhf5hhv N5hf(jhhfCJUaJmHnHu#jghhfCJUaJhhfCJaJjhhfCJUaJhhf5CJaJhhf5CJ\aJhhv N5CJ\aJjpb $$Ifa$gdK$kd$IfK$L$l F   @  t    44 lapytjlWIkd%$IfK$L$l=  t44 lap yt $IfgdPK$Rkd$IfK$L$l   t 44 lap yt "25678;<JKLM^dʵʩʅzeʩYhhq]CJ\aJ)jlhhf5CJU\aJhhfCJaJ)jhhf5CJU\aJhh)CJaJhfhhfCJ\aJ)jhhf5CJU\aJhhf5CJ\aJ#jhhf5CJU\aJhhfCJaJhhv NCJaJ 34t`Ikd$IfK$L$l_  t44 lap yt $IfgdPK$Ikd$IfK$L$l_  t44 lap ytdlsuxy|}ѻpeZEe)jhhH&5CJU\aJhhOfCJaJhhbCJaJ)jUhhH&5CJU\aJhhH&5CJ\aJ#jhhH&5CJU\aJhh CJaJhh C(CJaJhhH&CJaJhhv NCJaJhh C(CJaJhhfCJaJhhq]CJ\aJhh+yzCJ\aJtuWIkd'$IfK$L$l_  t44 lap yt $IfgdPK$ $IfgdPIkd$IfK$L$l_  t44 lap yt  ʵʪwlZwEw:hh C(CJaJ(jhh C(CJUaJmHnHu#jhh C(CJUaJhh C(CJaJjhh C(CJUaJhh3eCJ\aJhh C(CJ\aJhhOfCJ\aJhhH&CJaJ)j=hh C(5CJU\aJhh C(5CJ\aJ#jhh C(5CJU\aJhhOfCJaJhhYCJaJ <>@P^fz|ʵتq\N@Nhhv N5CJ\aJhhf5CJ\aJ(jhh C(CJUaJmHnHu#jhh C(CJUaJjhh C(CJUaJhhH&CJ\aJhh C(CJ\aJhh C(CJaJ)jhh C(5CJU\aJhh C(5CJ\aJ#jhh C(5CJU\aJhh C(CJaJhhv NCJaJNPd`Ikd$IfK$L$l_  t44 lap yt $IfgdPK$Ikd$IfK$L$l_  t44 lap yt$&(<>@JLPRzo]zHz<hhf5CJaJ(jhhfCJUaJmHnHu#johhfCJUaJhhfCJaJjhhfCJUaJhhf\hhfCJ\aJhh1t\hh65CJ\aJhhf5CJ\aJhhh 5CJ\aJ&jhhh CJU\aJhhh CJ\aJ jhhh CJU\aJRTfhjlntvܴzo`oN`9`z(jhh@&CJUaJmHnHu#j5hh\ICJUaJjhh@&CJUaJhh@&CJaJhhfCJaJhhfCJ\aJ)jhhf5CJU\aJhhf5CJ\aJ#jhhf5CJU\aJhhv NCJaJhh)CJaJhhfCJaJhhf5CJaJhhv N5CJaJdff`Ikd$IfK$L$l_  t44 lap yt $IfgdPK$IkdL$IfK$L$l=  t44 lap yt 0:<>@TVXbdfhjîâ|jUNChhfCJaJ hh N(jhh NCJUaJmHnHu#jhh NCJUaJhh NCJaJjhh NCJUaJhhCJ\aJhh NCJ\aJ)j hh N5CJU\aJhh N5CJ\aJ#jhh N5CJU\aJhhv NCJaJhh NCJaJ hhffh`Ikd$IfK$L$l_  t44 lap yt $IfgdPK$Ikd $IfK$L$l_  t44 lap ytjlnprvx@R´´´x´l`lVhhf56hhv N5CJaJhhf5CJaJ)jhhhf5CJU\aJ hhfhhfCJaJ)jhhf5CJU\aJhhf5CJ\aJ#jhhf5CJU\aJhh NCJaJhhv NCJaJhhfCJaJhh)CJaJ`IkdQ$IfK$L$l=  t44 lap yt $IfgdPK$Ikd$IfK$L$l_  t44 lap ytR|24˵˪t˵iZiH#jhhR'CJUaJjhhR'CJUaJhhR'CJaJ(jhhfCJUaJmHnHu#jhhfCJUaJjhhfCJUaJhhfCJaJhhv NCJaJhh)CJaJhhfCJaJhhf5CJaJhh5256hhf56hhH56DF`Ikd'$IfK$L$lZ  t44 lap yt $IfgdR'K$Ikd<$IfK$L$l_  t44 lap yt46@BFHLNTvxźЯФxfxQx(jhhfCJUaJmHnHu#jhhfCJUaJjhhfCJUaJhhfCJaJ#jhhR'CJUaJhhR'CJaJhhv NCJaJhhR'CJaJhh)CJaJhhfCJaJ(jhhR'CJUaJmHnHujhhR'CJUaJ`W $IfgdPIkd$IfK$L$lZ  t44 lap yt $IfgdPK$Ikd$IfK$L$lZ  t44 lap yt 48̳̾}ubuOu$jhhX/56U\$jDhhX/56U\hhX/6$jhhX/56U\hhX/56\jhhX/56U\hhf6hhfCJaJhhq]56CJaJhhf56CJaJ hhfCJOJQJ^JaJ hhfCJOJQJ^JaJhf6OA $$Ifa$gdK$kdr$$Ifl4ZF*8`,`  t0+    44 lapyt68Llzlll $$Ifa$gdK$kdP$IfK$L$l#50  t 6P 0044 lae4p ytSHHH $IfgdX/K$kd$IfK$L$lF 5TO t 6P00    44 lae4pyt>^SHHH $IfgdPK$kd,$IfK$L$lZF 5TO t 6P00    44 lae4pyt  ./02=>?MNOP]^_`nopruؽت؜؉؜~ncPncHhhf&6$j,hhf&56U\hhf&56\jhhf&56U\hhECJaJ$jhhE56U\hhE6CJ\aJ$jrhhE56U\hhE6$jhhE56U\hhE56\jhhE56U\hhX/5CJaJ^_vSHH $IfgdPK$kdZ$IfK$L$lZF 5TO t 6P00    44 lae4pytuvwټ~v~f[Hf[$jhh*&56U\hh*&56\jhh*&56U\hh@r6hhX/6$jhhX/56U\jhhX/56U\hhX/CJaJhh*&6hh*&6\$jhhf&56U\hhf&56\jhhf&56U\hhX/56\k` $Ifgd@rK$kd$IfK$L$lZ05 t 6P0044 lae4pytx $IfgdPK${kdB$IfK$L$l450 t 6P0044 lae4p yt%&ƾ}}vm^}jhh+ZCJUaJhh+ZCJ hG9h+Zhh+ZCJaJhhv NCJaJhh+ZCJaJhh+Z5hh+Z56\h+Zhh+ZaJhCJaJhhfCJaJhhf5 h1hfh*&hh*&56\hh*&6hhI/6zjj$ $Ifa$gd $IfgdP{kdX$IfK$L$l50 t 6P0044 lae4p yt%OMD $Ifgd+Zkd$$Ifl42 F*8 ,   t0+    44 lapyt%&y $$Ifa$gdykd$$Ifl *+  t 0644 lap yt $Ifgd+Znkd$$Ifl*+ t0644 lap ytvmm $Ifgd+Zkd $$Ifl]0*  t0644 lapyt  28:NPRXZdfz|~źp\J\"jhh+ZCJU\'jhh+ZCJU\mHnHu"j hh+ZCJU\jhh+ZCJU\hh+ZCJ\hh+ZCJhh+ZCJaJhhv NCJaJhh52CJaJh+Z(jhh+ZCJUaJmHnHujhh+ZCJUaJ#jhh+ZCJUaJvj $$Ifa$gdkd$$IflK0*  t0644 lapytz| "6:\b򼱦wuf[QJC hC5\ h5\hwh5\hwhh85>*\h hh85>*CJ\aJUh5CJ\aJh h5CJ\aJhsW5CJ\aJh8\5CJ\aJhh85CJ\aJhf5CJ\aJhh+Z5CJaJhhA 56CJaJhhh856CJaJhh56CJaJhh+Z56CJaJ2z¿tttth $$Ifa$gd$$Ifa$gd$a$gdpkd$$Ifl*+ t0644 lap yt signed and dated form(s), to the NSB Helpdesk at 919 870-4863. Division of Public Health Women s & Children s Health Section 1914 Mail Service Center Raleigh, North Carolina 27699-1914 Tel 919-707-5800 ( Fax 919-870-4863 USER ID SERVICE REQUEST for WIC ACCESS in HSIS HSIS CONFIDENTIALITY AGREEMENT FOR NEW USER ID, TRANSFER USER ID, AND NAME CHANGE REQUESTS The State Center for Health Statistics (SCHS) recognizes the need to maintain the confidentiality of information received from any individual. In case of medical records, the right to confidentiality is guaranteed under North Carolina law (General Statutes 130A-143, 130A-93, 130A-12, and 130S-374) and these data can only be released with approval of the Director of SCHS. Additionally, in accordance with G.S. 130A-93 (e), medical information obtained from birth certificates can only be released upon approval of the State Registrar. As part of the State Center for Health Statistics, the Health Services Information System (HSIS) is a collection point for data from many public health agencies. Because this data contains personal identifiers that must remain secure and confidential: I agree to access information in HSIS only on a  need to know basis. I will not divulge, copy, or release any information from HSIS to any unauthorized person or persons. I understand that prior written permission for release of any data collected in HSIS must be obtained from the source of that data. I will not release my User ID or password to anyone else, nor do I approve of anyone else accessing or altering information in HSIS using my ID. I understand that I am responsible for the quality of the data I enter into HSIS. Failure to comply with these policies will result in User privileges being revoked. That failure may be subject to disciplinary action under laws of the State of North Carolina.  FORMTEXT       User s Signature Date Signed  FORMTEXT       (  FORMTEXT     )  FORMTEXT       Printed Name Direct Phone Number  FORMTEXT       (  FORMTEXT     )  FORMTEXT       Facility/Organization Name and County Name where WIC access is requested Fax Number  (For NSB Helpdesk Use Only)RACF ID #:Date Completed:Initials:     North Carolina Department of Health and Human Services DHHS T932 01-08-13 Page  PAGE 1 < OR > bdjx|~02zĿƿ"¬o]SH<h@<hsW5CJaJhsWhsWCJaJhhYiD5\"hh/CJOJQJ\]aJ( jhhYiDCJOJQJ\]aJ"hhYiDCJOJQJ\]aJ+hh9T56CJOJQJ\]aJh+hhYiD56CJOJQJ\]aJh%hhYiD6CJOJQJ]aJhhYiDhYiDCJ\aJ hC5\ h/5\ h5\hwh5\¿Ŀƿ$&(fuja $Ifgd9T $Ifgd $$Ifa$gd$$Ifa$gd $Ifgd $IfgdP$a$gd$a$gdsWGkd.$$Ifl|)) t644 lap yt "$&(02PRdflprz|JqbqbqWqhhYiDCJaJhhYiD5>*CJ\aJhhYiD5CJ\aJhhYiDCJ aJ hhYiDCJhhYiD5CJ aJ hhsWCJaJhh0CJaJhhYiDCJaJhhYiD6CJaJhhYiD6CJ\]aJhhYiD5CJhsWhYiD5CJ\aJh@<hsW5CJaJprz||]$ & F h3$If]^3`a$gd$ & F h3$If]^3`a$gd$ & F h3$If]^3`a$gd3$If]^3`gd & F h3$If]^3`gd $IfgdP $Ifgd JLVG$IfgdK$mkd$IfK$L$l4F'H  6`'6    4 laf4 $IfgdPK$ $$Ifa$gd $IfgdP & F h3$If]^3`gdJL 468BDFHNPdfhʸԧʞ|ԧrcrQc"jhchYiDCJU\jhchYiDCJU\hchYiDCJ\"j3hchYiDCJU]hchYiDCJ h&YhYiDhchYiDCJ!jhYiDCJU]mHnHu"j}hchYiDCJU]hchYiDCJ]jhchYiDCJU]hchYiDCJ,hhYiDCJhhYiDCJaJFHxmkd$IfK$L$l4vF'H  6`'6    4 laf4$IfgdK$ $IfgdPK$hnpz|024:<FH\պ}lZ"jChchYiDCJU\!jhYiDCJU]mHnHu"jhchYiDCJU]hchYiDCJ]jhchYiDCJU]hchCJ]h&Yh]hchYiDCJ"jhchYiDCJU\hchYiDCJ\jhchYiDCJU\!jhYiDCJU\mHnHu!x $IfgdPK$$IfgdK$mkd$IfK$L$l4F'H  6`'6    4 laf4n $IfgdPK$mkd0$IfK$L$l4F'H  6`'6    4 laf4\^`jlnp "$DXZĻ~pf\fRJRhhfD\hhfD5\hhq]56hhfD56hsWhYiD5CJ\aJhhYiD5hhYiD5CJaJ h&YhYiDh8\CJaJh&YhYiD56>*CJaJh&YhYiDCJaJhchYiDCJhchYiDCJ\!jhYiDCJU\mHnHujhchYiDCJU\"jhchYiDCJU\npx$IfgdK$ $IfgdPK$mkd!$IfK$L$l4F'H  6`'6    4 laf4 $$Ifa$gdmkd$IfK$L$l4vF'H  6`'6    4 laf4 "Zpvjjj $$Ifa$gd $$Ifa$gd$a$gdtkdg$$IfT)o'l) t0644 a9p ytT?:8888gdfDkd $$Ifl\d (#)  H   t 0)644 lap(yt,.0DTbdprtvxz|~ļ|pd[d[dWhh%5CJaJh%h5CJaJh@<hA 5CJaJhy0JCJaJmHnHuhhA 0JCJaJ!jhhA 0JCJUaJhhA CJaJhECJaJhCJaJhA h@<hA 5CJaJ"h]ahA 5CJOJQJ\aJhsjhsUhfDhYiD5CJ\aJ.0xz|gdfDgd  !V% (gd/$a$gd@< 21h:pi / =!"#=$Z% nUgū.2YqPNG  IHDRu0PLTE1Axdp?˞6 eʺ. bAD()eɘqc(jVYA((z. 21@@@1=Tt0 &tG?*nQb n++j-*MC]Z! ,-ދx`D`3~+S0%'(\ӹw۩Њxxtv`v:a* Eaow:84Lleaf MsH ʺwH7R.xPeYWr&i`4}hwH ޛM^a$&mE)z;}$RQNuu$û (_+~|kA{᫏c< &mm뫏g|hW>͟UXBb|r oBbUěL;/ ~& ;~CD~^,#ӧ!etהzTжSTͼ~a ^-';=kB(xn~_M6R٠/-y+(L,QiŸD˦PoG S+J:T4/> N0/NêQXeI'aUsP! 2M.~ZGAM^~a d "B|7dz/HKs#? I! !]M ˼SϡWԊMz+/1P*>5g~ b`_0n˄!Ēj-t_ MwbZ5];ƿ"jЕ]xyڝ_,&ǷTG97G> PLv`i tPu_knPfEӶ1dW7; ƃߚ?CQnW|AjkfPK:6.z?Yӄ[TTԪ #M*xOʍo%ߴ`)PI/K*4 $,4ȃQ~qZV~ ^ں8{*xM2y=P {WoWA G?=^gk寧OAF2Wϣ Vfo\K@qL|Gw:o\A 1{7+)x u\v?l7Dn)=)xmdgŇn)xI&A*}c귫53O@߮ 9:PL'%[]^vtp2t( * Z;i%]6uj=\?GkJB_NA,} :b#c*xe^Rcӊg6yWc>l{aӑ/qG?^߿ѯnw*װ4'=,{UvR̲R{j=<x_l}PÏ_ǏJZTY9QsSPCrTh%O_QRov~N!H=^8^8g?GRy/p 6^0Š'b!.ixM zc']?dO~l~鐛&8I~03|R_ɫ&qD Kn cF򿾹pwR$^ P;)07 Z mސJ6Pz5 `n$Ftko~C~T9@w >-N KrĠjQ9O NGf }NI!)e6b#6Fk'τE4eN(,2I*Ŋrs0Td05>k쾯OE92Py 1 IE sܨ1.AUB&sʬ<'$nSgЩR\BDRGh,\g >YLqEzBA{ k(0Ϫ\B%IFam&7 ^Of̒%}yh4l}94 8r!{Ivt7QfcF#k,Jn}t+zԪAq.%J&b^"Qbe_e1 lD=W8<남e@WN 3q.tcY5yƠVa*d;էЏ4*s f ,[L zSawv0(j4Ȳ9I|Qvi֦$` KeT%d QF4i,+>g(3ZiYrբe De(-0D%zT؂rX*PEn;0uƧQ1 p1@D[0&kQ* Zh[*R$ӱ |bu. Mft(UJpv8¼`$n\ HfB ;PȻ >wih(O@fС2\(|(}qVl@@y tԀs^qΪ\n%ņHZJO*RU %ӅHC̢90ounM*VYbЮ$7x Z3BW)|d*+Ne9d* qNJ<ǿE7ݒ\:ͥ4I$ɜ<8 H$Te2 % +\)Eݔ Z^bQD-,3'л?A_hY9Y[s #)І[ߙ YkIENDB`P$IfK$L$l!vh#v:V l t65m p ytDd%D  3 @@"?GDdQi%wwV  C 2ANSBlogo-graybT|j={=y& nqT|j={=PNG  IHDR U0PLTE{bKGDH cmPPJCmp0712OmIDATx흻b:DN_vx3*Bfڝ%@W?@ddZ@DkfǓBȁ!…KE6]972bHS!cA]cy`#YStxӹbݐ /MyT^Sjڎ:Pwץ=Eڟ_~|ҶSZʣD.rTbʁ~*lֻCeT. /|nVvĩ7}SA]YzQë rP丝Sd{,(EB}uL㞚SVm5H5Gc;jw$Q9THjG;M^RQT?.67Poɧ\.6.g3(jX?NvW_&WA'[j_[f9uߤzK>s uiZp_Ҙ:Wob>穜OT :/e9za1uJqhiOh}?W-h0SKF-G7̥~D:hBQQw(͗VX~Nb~8ޯڝ.TN秱5E2Qz˜:UZMrR@0 r9OZy{sq6i|nrڛ|4hs~ r{5כ֡ ؚy;^ρPwץ><ן}hKKé߭j/uVNgDՒJ%K !;զ G%hn@X$v]HԩrP[9ƒlvl:U^H}絿 87C ٳg@\$V(mﯔrz?E>M hҲjcT?/u̢l C-nz=BOߍkO~?h~|D8Z `)~Z/͞iOu]:o7-\|~ryr?Z;p"9QwPwץ=؍`=5˩m7=KXտ OOHG_oU֞.ٗkzw\I{)@l@Cm֖Wzs:j^=Y4jͦ}UZW+_KwV)WfҞ+LwdIR'QWqVmv_ҳ#Rʯj_$ӢTwρPwץ1ώz4c?LbAٽP=Z?,G,\9"^hUkyUJ^ xdhPS3-Bej֥f@hڕ? jUF)W+yi~.W=K@ҞMvI,-u,ZPȿtW姖Iny_زRH\J)MQY`u<$z9Ǿgk=;U?-_I-穙D;TI7UC3)ǹFQτ5movivA:Z-J&@z4g)<&q-Gz.z׹V[l]s- ҫq8ρPwץ=u(݉kn\Z"+/WΕ֓GY>Vy.3VC^M\$s.]zui}]=u,罴[YljߌH/˕)uviˠт?c=2Xb!)k=4PaN["nu\}5|:UO˕{Zv4Z\gz.JHW_fqWRjz: SeV?v_hsٟ vnMxZt+^Z.髪n]0 iKE!ĪR1\O,7т?c]5=sv NYPwz|4ݲPj=T?*w+EUN~\٧F vMwUsP`uU,$8eG@]}kzT~u7Ŭ\Úǧ&h`TVK)z.v$XpZ,{HVO- _k]N-fed?+nnҫ9jz[ A!]^=*[: ҾR*^uk\QwusP7эƒKiR`~*;I9ݮ/l2FTN*@Ϛۿ(z.J3$R7Nůە"Ts޼&K? n]nn{C@]zҿӭQSR:`K(T^n@Vǁ>r^ȧgPD9hWqV?FFJuwYjhEۍ5oEuO*_ƻ毷Tlu_+n6r^ȇ?4r%th`-Pw:T=DۍM]czZJTNbJU9)0MZ5+~Ѻޫ9Vn<]V%P-Pw>pk46u-ՑD=ܚ6T,*'&RV͊_.^UQylmW^ ^@{Rr`kF[1mBi|b~YSi~4* } n=76IܙӍ==-n殨\*uVVhiaT+ TR5,)n$P.˿y Vz|^iO-n殨\*uU?ُ4G0zJ)} n=)s%ʹz_28֩zT㯱k&.׫]iojytomU_hg RJ{O\5;}Eǥ~:7絵{4rWTǬzU闯gG5^إFr#כVJqSwIy+aR?^Ҟҍig2"x⯽OIw5cBXuIE8n]dU܈ϯ$׹jw}T/-ݘv&Srjk-rMS+$>"jf^JʍtLAh>7uUR=^Ƶq⯻ r(*rK;{}iZ)Mݽ'osz_3ޙ^`\;ѸW݆J9kGYFw7_- EVJ(KJ)} n=yLzn3fnu[QtWt;}jӺHm]l˭VJf_8>W5)U'nzߊʵDni\MN F_=C/"Z)YdqPwcz[[:vu^lhwWV*+*O6(ՂDnGQ$:hyRB ,Q]?GR$ B֣.*TL(*׶ Y/gI&bV@EMX4B걆ԋ.gUmmWwʿZ,khm׶|Zľ|[mz**<"9Xw;.JR5SG Wi) 3Eݾ4Qiv6Xaӳ]ϩԏzD;+ݍ;]ҜR վ(Kz:JﲿWfӳ6ϥqKF#t7}alO%M~^h4LiT}j'ՎbJ#lizB]JhhY3x{T)MK\2 t i ʪw'RQɣeڧIρPwE3i_"V ݄kW1XŢLd+*zDxE~V?h,6Ji{l_?)Obwߣr6?#t4='\%[UYCT _5]R3bj>x&_#kTPZUfxJSٛҜT_=D&& h㭜- :VeUO7@ʣm&/U)͙~x_cqn9{H x,~.]~AuzPxܿ<6[/mrB]z<%vjg{)8JU}B!by$[UYCFZA.yCP" Aw|DEx fbCH"*g3Hw ~]x6곅#'z<믔(^' D!]gO5{~nrơ5m&egnKHRrU `;f~J`ߟjʩjfd?"l6u'hKQ? x_wr`0݉|B,[ک\MQwQ=3fc|bzzc%s.+xv?<]ݾ4uNl.23H.G_ {!oe Z?ިD:RZeI~vLI#yOivJi?z-8s:%zG<? 24;C(9]B9.! uBK!B%cBȱPw !Xr,]B9.! uBK.uȳIA%WJKQ>]rj&yvSuvR쾑'uEdfPwif 1g͊Pwl0{KVfPQ٣5.Yٲ@#-d* d+O"ϞȁPwl NgFC%dw\<{PwɑTrUfO.9m^ېg ue߀KF1{ye>B%^0B+B%q^'BL. `<ɇ- uxf !#cKl^ BbPwWb=a>9bө+͞)BHݕf!OtJ)B@tJ)BDĦSwWbDB$"6'"݅fO!D"bթ ͞(BDĪSwb=Q݅fO!D":uw!EN]EN]EN]E XuB̞'BLSwb<BdVy":uwD]6{!2ٿuf!D&wljN]D]q" wu:̞&Bש˰͞&B٩˰͞&B٩˰͞&BBv/;uwDAe.6{!ٽe=L^v2&BDv/;uwf!ýe=K Swa,B0N]m,B0N]m,B0w۩͞%BFn;uwٳDmQ"dSwWa(B@w۩0{!(mI"x 'v"l']w"l']w"l'N]m$rsF*.6{.u.$)J]Kjucs.'@f62"^BBȳ7)8uw 6h H% 8uw 6h _6{EɳG,+uw IG=fdkaPw='GgՀgOdk̖ g|Nuw f}ɳ[Oe΍6uw f%ɳJNMw|K͖1a @lul^LSw`vTB>8%8. !t2LSw`l/BN uPR Y rzq+F]>݋'\B{m6LZun!W{m䎬>۰@N--uPwؖF{mK%'c[t/yv N0kC%w;[L uwvN1KC%7߰Qw<;B4TF~vH5WKnIxt{dWƯ3 Dv9^.7thY(ue7΀d;zW9Rw Dv^.'{]΀ݼ)b^hzׅKώFkQwG74۠ţ·KĩS^ TO 6;2]r-^}v(ݫB%wb;Wl;ᩁlmQwC%w⟒ّV;~c Q@}RwC%Dmٸuwvh;yv cz.u}Fݽ&]r+.k>dNKŵtטuw2^ \Lw#cPwɽ5ېNKt7Rw"uU$o]0rv=fWlXw^m Am 'uw.^=аGGF]6uW0QE9T1([+o}WVWq#f@6c-jU,ɧ=c OΚ㔺wݵ:A,ZQG'ַؙԊ@ZVZ@ݝ)u82kꮃ'*Cu^wM DZ{8 +G%.poSǾ|m$ԺΫ@$VWa2]6{*/0.)ଛynMz K&' a( O#A+^yDaA{l`)A.)-)(rK'lw@ݽ݀%+IdIk +{1$V 7y*H7+Hw;zy[w' jzO}yQʔ*n ҋ0ǝ.PwWv݄-IdIm *{1$VG 2,*rI6RwqBݭa\~PwƔ*~kybkuB8qǻE3'^-'5ŘX%چ ҏ cY@+/ziƵt^J~o<*~ ]v_UUp㌠k?APA7Ept_OwlU.2ڛ0ˠ8L⸘޺y )򄣬ʡ H+Iݝ{"Uk^< B yReU|Fbm٭ ZAWJ"u"\Ow9 yf׫8±MuWE=,,}?K⸞޺yB7C:*>,4EME&\'uwCFq8Y&הʄD ʫ] knUܼk⊺Lwxo,92!%0yr@g$&{]w^$ [dl yBS۝+XSwwZt7f)\TwÎz.kFnIR_ꧬxd%s4'nWyh#$ 䪺_N:So_'uI݈YM~Pwg<'"zR_ݰY? xhd@٭>fH2@7)Г$ngtYm0>O݇:vIW`0yBgc;ub;+YAݝu7.nݱI8yTPgy1L?nR) ug2O n٣}Hb~e^J8"$q\[w[՘pzy$f<'񺫜N%⺛ xZokqt; *vM:^Mc'zc xXE]Č'gvˋ\Dw:H3jzR8I<3Nu,/Lv2!+grV謧C3Nu,Sw!"^)gpzy$SvI*uR8B#@w4NR/8X}ʮٌ]*fW YO[#QI):}^ۉ HqW{rLA^vt֭Rᑨq>?8^)P7Ժ+t֭Rᑨq>Ɏ#u>/PwOMt7}^Fg*'OFݭڸݭEvRwgfwÎκU*<5NAzuւ{nh^p'O&y}iݵb-A/Ou/n D'IRcg8'/ݣ ifcYJGɓ?}^_[wѭuԜXwj۝Tx$j<2uވaVX{$)zp{*'OFݭ[#{gN6ɍ;/VH8y2HjlbW݇|[H~Rw&`"oX#Qx0"}\7ʳ(TN *,=t7w^RᑨqIjH`t7XvctWE"u`n/ܸb D'π&q}{%u!*B=1C ,nX#Qt.&}\?J(U{^pZYOTx$j<2us pCDzTx$jK2F׽qKH`z;귥˛cig=n'd{' ; 5.PwOuGwfݍ{$']Ϭ?n>\]wY|ba ή{4|8>!ݵDYA=%f(\ogϫhߓ>IwzyeHH ]`;n]OfI .VH`3tZRwck!ϋ>E5+k\CXFcf(u\Sw]k^W'y} uqLԚRwd EkZ=P7f5e/ޱ6Ews:~u\Uwj7nF]\&X.tP{>BfpbeHq32cuyhb]? uWSq=;:=n(k$^\{c @Ο#@=ݢoa֍Ql$ (Lߵg; >;<o#Hf0:jv؍vMr]e$;G PwOǕu{W7f5e #vֱvK)hТMwgV :q32\;ݱ}^gtF[˰M|^;vFݵ>nD(*'!.A׎:Wkar]\w³PI0/Y/v4{6SbFpROma7Vxfz/r xbSXٌ&^{;nvp^[@m,ujl\bxyd'u@oB'v}U8V%-Sw+.O} :;7rjB$ &Y7B <*9XB)GVP}۳㔺{wB3:#RB-SwRdMTn0D0o V}.DsV@׻EIjˋn%PQ}6Vq)ut9SS2Rw[(Iʂꮫ ÏK5l-Q7@]7l}H%Vq}*O#u75y :;1u՝s.wZHjz_}9Wڂ\1 .㜺 {R82CRsV`׻yK17O͉ݬK <-rr"=Ϊذ'դNk-d!4dM^4tIݭpVxQϟ3;gu xXY%y "faqog%6}GH\J>Ȭ''31HcC>hȚ,yY͓,] p^E[} JY^WWù#tW)դ4WwdNA Ī?wH!PcuEhRyvȭ*{#ni8Þ,TA9S@K ݬ˖fRyRw=%BkK3f qy:Ød$vf)W{Ի6^D8yJ x &uq,`,qiz\޹Iha|F{% O#I:0m<%Ǥx%.OӑzXS%sYݝ*Sc%ٍu-SSQESR]Q?71 S\#0O@$̖R!ZKvf$T<%K]s܋J9uƦks|CFnQÀ:q.+lt R]; ?v45Y -&QC b+;:ˋny6KliyC>ªmڏjOBbXCDd[Zھ]ꮯ$K9@c>(ίZx# s&uY:`LKDJz>\$b^]741}Ghi)fI`+ݝMEez*}R*d]AM{t)K&EhhR|Fe[*d>Quf^T G uO&nk Hihn}fk_Da=\۵(nX,o~ؤʴnm*;̖P'b~ )I&)vşb t#H epӾz jh xHzw9~Kn~yJd|ݭQ퍘EMJ|48^S?!HN SY}`SY,]~(K;xϊ," kf]Y7ҍ10)!nm#K &f7(zٝ֜ - MLw%IGY'F-˸Y,ֻ]k9z7Cx!unݭ+o:b)ws Uv9KO/uy{ ]Y(ާ{O:1A4o-tPB>=(Q8룺MܞF~7+Ӂxt7nJe,锳q1[vdE}%Pvr{7yvFTOU/Pwu;{E` u-VvޯJK?j97ooK%A u7\v 玄Pw]QK%ĈFw)1_0lyb@Aviv' YPwQUK%DB6uצM7-[IPw2Nvc?kX^u)t$cW-^BPwcQQun5[PAv4nQwٝ-8IPwung _ŔKH *5wk>ٝ R˳JPwex~צ6~0]}̲4+ﲲK翗.G9mEgBHꮶ yZynꇨ4uBJ^f;ˮV)hjKce7!=+BJrKv fq;BnuW1ñndWAw!Pws EU,k&N gdݭޚ؁w2I٣ (A>{jwf"if[Q5 P:/KM$17qu^|0=Fwo"E[pѶ w #nh.1CA qkW1.N'Oєqj6C/ć;xE4fT}쇰W@5\/NARӕݟ9^Io}p샺r{݅1Nv-uq,K7T:>n,E]*Xv#%#uvW\8c0Qz]RT\?):}.XCb#viW,u(~-KoFg/Wu{zRwZ|f(j3>GgFj3*ˎS\2".-@{U5jvu.{!BV'Ul3uL( 1_яlBQ*`RPL`2'-uo=]Jwo cu7 PdQ4 ƟB xÊ0Bތ^]v}_`7msRbU_iD.cNtF/t):]bk6|yGK2'E,vbY[)uG"0gJv/Ȼ΁X9_Lo$<~uEm` pc=(#X3zE(̻/_ GPݟ: "-p N7NrkLvQu"PTNv/`ص 3o^j v#nt͂r$񄱃EW uwuZȄ"H0bmj)a0$]NPsx2,к;ۏ7]$|P,M!1iHr/de~Pw ŷh1iLrU5mKCR*HBB5А[TqsR?|g!b20bG##!u?W̽n+eb >ǻf!b "!ˆ!ՎE7x^Dn+x5)})Cx[f si՛,vH )R_>pu[Aum)R ]}'wɌ8Z9-JSQMRfԭY}Iti>gPm<5tױ]LANA!u!㮘U?ZVּ-*K1u:;^y+. Ch&A Y,vf%kHD+Pw},K ǴTfRhG5igJEEnAnwf;<'iax uHBrnJ {hD:`6ٽBo<{$̨H3]P5ݨh AQyMj|w@ 0|A7EmBCXzec" @0+Q8`](۱!mNC%U$Eo?EQe oްdN(pnr3'(@IK)ÜC`usߎ]%sˆ`u)'CMmf}→.T<2 ;fO|.$m{l-gxGW˘eE'C>=\(!K,[b@I΂JUuTw/79pӆ(6UQuЏe^wF vj^s{݅^4@F(F㚠WH˞^b +Ut+8t6 Nߙa끯 <,zFi DY*{I#fFWt1 ݽPy{Gu` 퀢ۆ oY=nP ^NfPaK^]/guCi郆:smΖ^)CQ,u(\E;`2}kJ̩q"N+A]la<4W lsLQ6BThMPQL.AkkS;x^x+E c%*M4oΗ`ݻw0n׾(}?~I7)^l3Ca%*j*6,]FDŴq?v75.i&0xwg@Y`CgGHvOْ;O1oNK9ܵii7LYQl8cS,LhsTcathZa4y~<\w5O# unƵux%P$E9wgЄ|zl*j@#:Mpk\ G]6Cw;.l5i?Xz7ݓ)? >"i5nN!}".܎#iu7R Pbc+h[ }G4 202{~3xp;)*zR5UsOPecS& `:uh3Q9 h9(ʨNS"W  \Pkh:{jU`P :3Ҹ96p%JTx -JR\S3g_*y5p(ڱ<28 b=2],h)K `e1ǒZbMBB&UHp̲P'ώʑGkؿ-X« /^ bMڞsIgW_#n #/ >jnWW^ښ&}4 [U{Uj]2Fvϩ8<362?9ޣ7f%}, ִ+'LV?@kCvdQwՏPg" B &}, 9$#iCVe]+Ԁsz4BЍ<^;#?\>N~N-zH|$m]~F=sf(ϛF sD)q'kEx@[f%}( 8JƨL[(=ݝ]ȥ<ޫ(mEoe'7+uu5QpZc.1t7M rLu5#IL%INw'шĺyϠB3zU5ݢ7U2  65'ꮮ{8t>FXrD`β$ѓ7OcWU o\ipWexV]ꮃ;9{tW !Fwuq俿뉜 ۨz)̅zLU[פ# *tL!k&NQns ݛ^4ۤIFLu[%[.iuwRw]STF_4;n?k15tW;"QM:^U;m>$*unkaTx37u1[z{լU" [MţVI?>R::'3u '٢ Ctm0 Nv<9vc^(}7*Sq;HGDºtW9QphfK6n4u˴Tt--j۹INNp.`k%w6CHAh͠ƵyQu7Du~gm3tsƊrFI]JDūdvM 2VJݝ-]7&M_͋E!74߹p 8Qw٢ #t״rqS0W(ItħZǯJb!6u;v d* uz6VAT zMRQ{Kg4mkXd* lѥJ?zWkbv•4$#:AY}>ݵU12?=f @=T^w_i{ykc}5-܉"]'zEMJDEt(t4UceLbV܎gV!^wbX &fN6cMd%9cSD_5n癏{,퐶mӞ dɼ[]~+HvҕpEsfEc* lͥxV$6hٚʯmu٣* Ňr䲥+3oݠ5-]D y\z!N}=. _hA& 1e/ըk5-C=ns70vu~"C)ĸ+5-V%˝Pk͢]܀)IW}zo ']kJΊb30s(OU}೶$,B7QozGwgKuoK ~ k"HN2f-ͭޔ֫T/*'][w;`ͷ1-~dKT"ǀ6L ?jz8EwRw!%bӛ]º/^LqkpgB0(7;b370bz\Xw#xCeYtw^Iwe2">Vw1qūA_zP`lɽXa)dL/z~6. soB"zg(h8ĆKp/`)S5wxQuI1%6 9Q$;[rO~8pSJ)&4;M1xa>V&"uםA[& (0^-yDfNCTy/mn^Iq#0 ={ j:?Â7F2Qw/Is{+_alX|'#Z?}Z3(QG68` `}ݵÈܘGTnهi)÷ (pBQ|u+uR^ Ֆ$% k,il1YZS#!T-@Dݝ-x- 9%edhT۠J=8]S|dw#5"W1q-R ƴ@gT)sꄷ.@|ZX6ٶ0n0˿ڏmAX;[r Ly>~ݹӒO4Fj!J4h I]Uws|ZX6RVЍwst7׭/v-Ɋw՜>ٖ]Stфge~Qkq2{#P.^v 5 Q\0d&+AuY[wgKOrxV1D״d\njExocIsZt.!j4YqŃkJv>IA+:t&:IBE-S`U##EuW/GxݵMvg1 |;*GBo} 01Zx]t/Y]8`Q}s vϬ{)YwK~$UEC7E\mdgaݝ]@P\{?GLegK~h޿X"8[Vg]fk  pk Eak}8Y7ho}ÊZՄ"(ne[Xx+EMpJ畂IQNy1K~ ſw7ORZv+^K+|":`]ݝ{em9e/CR'KڮZopo+W-#EPwq {%/_`,2P*6[t~ܥyU)AK_0 v'%UFF橆ʠo [٢ҏW;xu%{I:ңzAk`+\E u+Ć3C~ \ '^1 )3niR06OUErJ} odwQ_ :(E9U)lk(-k_tA *cV*n|1w{z[5jv lÍ/ `DA:2[tܵ+6 hۂ("O*B,Լn*U]CPDy 1SY 3Rwzo-f F cEݭ#Ӊst}rYu<͠(ݍOFMvgpC)3.@Rw1 |1MøErJ^Btcݣ'tHݝ,ݪq?'"#.Rwոדe"; ]$}dͳrME?fL3 awCt]%/݋êa UFMQ]Tv28*FwiwW]eHШ&PwUuf]] dwqM݅wm YtwqKUit7 u0_w;8o"gqB%d:}~ͳC%"ݩ{kny& ?uKfw1AwU?!ҽq9@ww]R]rnPw Cd?ٵWqI݅eK.\ݝ*yvUOw߂I#بg_&dMy8K"`fFՕ%>(+uPfgVLg^GΠ*5a4S3_Ƶ15.@&uy]w-]2`4:~ӫnn;.nUJ` 2$跞sMݕkSwįu{d^Kn3uW0?jd *{T4n6;HKqqݭF=`=OC? ЭkC&Uݵ^/cUl$kVズ:itltT%ƋCG$ ;rx MUnl@Fx[.6 ]LOwnllu]\ R Hh13[w5 .ϐlu]\uW2,9*D1+u.u3COA] B1Y8|$w~4*sPKK!?z+;žg 8O]Sa4j{f{a@"5Y;zo!-Pmh촼ʞzqNݵz=<;Q]"\^E$,Ftu4%( U.a7ɬ1(,+eCd_p|S&JLV-37sn[?Rwb<ڌ1:f>=]eԡ3ׂ7b;*< QGv mX* M8PwWuzg~0CaT2qj*'HuIbP ]tc *vKHF5!!QRȅx==޽4H  1QpD]iQaUJ-Kuc]J|s^ܳ/7?_c hڊ4wW6֊bHݍls}^\{D9M~(ٸ UBcO @bB/ݵq5ި#rTԂeևLl(C7QwGkP*|LuW>Gx8(C7ՕC0׷GቺBq5ބZB*TTbnϨRA0)\ZW@3uz̠x(*5"J>|-s0U:q='MqeGt5VieIec 21{Ssv^ܡW<1 V࣬|WHE\@f .^_ΨsV{°NVhA_ݫp49Fw+"^.h S+IgT%J7vP+ s Ssu^&y&H7XPwe7 <`z{ lEщ^zb٭/P;TT__+ ss?n(tוLΨ < hLɖZ-gJYtW-~ώg's>||'f,^ouFXJ)T="4.VN J)/u18X|))zɕ:@]l8"6I;Z<P~8v'!~ON16 S'WÁOqYblMp(hK2պlճЏX*M|ʂ^ S'x\PX%dtճϽX/~cЀ^ә示뭹#tO_)z>eAc)<.Z,L&eCi&X4oXu8 ޚ;FwSVD[8-^F?kFchސi&V| o$Dvϧޚ_-[8-^F?e,V߈5e}5i&V3]lޚ_}t49`Wc+nR_n} z^M{Ecv(N' 寷檯W)z>]E82l vL4y1`jՠx5.'3N_o"ŷ{Ec~ @Om9T_ǯ~Sd^']e0t{2/֋$J"rzk:~ "pu'chtvM2Wt_\3/֋0 ·{/.dل\u#oj\}4BP vL4;ޓXnzx5.BJaXbWox_|AL_oU_ǯ;Z[^Dw \biF<"17HAcel2{svLϲThK>׹J}`Mn=XI׽9nA uKP¿zoQ2hPaFy4HlY|ѠVwt,n4=,SZ[ 1R|7W}hߕ>\֠WP~7u6,>{:!r {(dI@cNQ E?\YB{~m:$5&{ ct6xQP3BjсSbc"Ql!Y0x_ט@ޟnz/jcv+H)Ƹ=F%ore )jIQbEu.IofB"u Pa ҁ pA~OQ?PcXd)єKzC Rw_)re1O (N#*?|7W}9k.UA</+~G.Ħ4"*K@ڢt i a߳nXZunwųPP|U+۷:[7G!:HjhQns,oޛ}%֜"?[<8\s]ێ*Vp䎖N-@!S0-m֖v{sP]F/]:w#O.5,Œ{h[`笮 " _8e  QF D6+V!&v>-뮾dzZW`vLF6Cc rVWQn;F, q =2Fu.!uܸrꀹ6dU@ݽ~WmSc(RRx H)u7~S~JVyX]3$(rwn')d Vqwa=fN[]l) ]:6"쓞ҷIT9ō,5:m$?]Km("yv4&uѴA @Xuc9F꺀m5QKnOKme;H.J?ФQZO˝t7]SwQ+nlOevaB:F[lrhvن,H~RwwMfvABFKbpn/\YSȿ $secn#ChRӨx+bԶ݉\E HF@~+6튄%Jjnt1:Xv/.kAU,hiH‹7(QRgv?)ŃFeT ^Ii;D/f)4^ve !zCjMޘwJ{OtG/}@RSۮs{[}CV1F#ZnXVm{Ņ1֤:ДJVF#~>H;I5qc:$$vu%;dQhS>Ф0 Ӗut&K[KKP?Q0!i#O)$`1uty:瑥~6?xIwiM4bvǟFaa%'(,9N~{I? i=; j΁$ c=FW h vq 9ΦFTDlIU]/Da]/]KmH~0鮥rڐovz ;0<5WòuE&#xs}7b;Vl G`PuţPa?A=a UoX~0}ο\QYӆҊ"O|׸hcky6F^u|ۓ Y )UzReP KlˏnwB؎RcJ =bRN thPww9ff`Ա ӭ}I)zر;t߉-hs%ίFY>#j!U9ҥ̽Z'uWw9iz! 3rFxm-G:Nl'ީqr19PUiJtc;;`FSa/ M3,C!X~0=bg}5cY3.vv4F_U >fH!,N?ЇtW]K7W4,vv4F T|~X$#hs}ޣ9V+]˂nlgGlFZW#b^ybioEP'ЊKrR- M7ROyĒP`kzMuB3҂K1;1M'žikA7 6&B}j${RC2Yp|i}%paOˤjNȴUn ZJ,x8B뢫"ʏt;IlT3hA7 6(1 |wNNN?PnkSL8eSJ=OcJFPsvML=վ#`ۺN֙d,3JO x0]R-Kf?o_?+0cl}&$U{u镎uŇ1Î}/8@[ K?#=-YA$,lĔ,eU{ܾ0Mݝ!N/ҞSD7V%<+(P#0-rIp ۫7_?І N+njK0luwU+ |!i9k='hBUwXgc^|lB-T5R!s 1ۉ~^[skZ[ vf5 JX.H>טe+1k='ڹ5uWKڟfST7Zp@B.!Iib9^aw[czNP׮~fd֔Q$/IT& W#mԶƨ ]% ۅku4%<9OP[҈[sl]c+uF7KZF+B"IkPxbfQ99@*{l-uLu=ZF;<!KI8 'WykzN5uWbHyH^Q~,K߃w0'Jij :>{{UQ iXw'(էe)IZCS8t7ZwSMuu .8gE]̶:6j>Mw;VNKp/Y|T1dv5Xw&][zs)rt/Gh :Zr#C'-0nm呤_-ܳf1,Vv$d%I d|u^tX-;eγOwM{oDo0cch?C)G|瑺+3w|N b4;#٢1[w0#sBQ/¶4RwEf9Xq'45X{n\t+gBOwg()ȳ$l,9YG+1{~Nol2yTxu7& 2#E^^;A9̢gWOgyU2%ÁLU=nl;p}fϙT<d6Q2v6jtv)dW(TlqunAr\^xqO~h:+d>G]2mͧvȳd^vX!KwQ^s6JʳKBAuzfOJ K2t"9b;:?Bgr)f8T]r09|\M~<0P!Oݍ 1{xN6l&Yr%9!{Ϯ 9DŽ"32l(Anܮ\sJF֟-%yBQ!RwցK؀䒘g%by =;dk@b7"gK_qr%9'ۘDu4 [g蜕}cov{- `.`pK"- 9#uDbÙ]'23uDrݥ^@CcPf{Fc;6H. T.)&Kb-KfXf+ GC%w8^mQRwI,]~p)1]l50d$@%3uܓj"Ϯ0$&. $ݧ`Ω]lޗ$hf맙م57{J]2z]$3ީ\''uFuwV].E]Ҳ;-KgbeKn-'ٞمu܄ݝ**rBB6b ]H%w!bky\5G%wݯ?. !gg1ɲ !.o6{`:gCrsCѿ.>t'iV9.!kJŴ-.`w<~Auͮ_ND2{D2]r'ȳ+EgW/]r+Sjwpɶ5hC%bS o qIѳK.g'qͪu5_aokKfedguDnę6;lD.[N`5.]-<;%g'q(,T4]r;FgǾ(]r;kvB%v9Gf,]r?{LfG.]r?{HnS"=]rC62@%7$wv*ώ|e5;;B]ف ucܽ\ف/u>-WKn xGV)|uPw)ώ{y<9,Zuܓݽ/2 .)] [uܔ<;PvA%w}loLyvاKJBu) tDB%=(yvkgvЧK u76׭F4]r_xg0 KK9TQ.1\#k>qw0]rclr< K xkގOun\UfG}&؞.g,uܙݽg8]rk;;.5yv [{3V$ώTPwɽ <; 2;sA%wKQg.#WoC>]rs/Xe:8.9VyKnNI̮uꮻW0Dg/u>𺪐gG~>Pw|=.!vɹC}3u>z{OuͳUّ.!B%$DwwIPw  w}uHYOK?he3 wٱ.!=f.]BC%'g'q|c?)]B~T!nI[woPw IY u_Dun3K@%!88.!<; 5v&BwOzɳ?-]B~yvG&=;B%7G.w@%!P{ɳ?/]Byve<;C%.wgA%!{$]Byv0.!]_K_lgj#Dw,IvvK?R$gyvK?HrU|yvηS.]B S< e]|| <(yɡ]t. uBtw;.!/x$t7š=t-uWBtwAK١[N L[9]B^S\:S@%]Э8?]Bވ<;NPw y46̳38?]Bޡ6@%ͳ.uwσuQuw.f'p|yv j^K'¥ ~r*|yvc% ulY .!O|79]B>>,Q|39]Bv\Wwo)+tB ;;@%dW}8['FwS)JE{N u=^}Zro$'KȞ ]N>rVTzNfT*ԚER!HwSk.!5'sf<;W rnpjԒψWz97]BnG\Jÿ]B\OwdrzTqԂOeR%JwDq7C%uw<.u:[#(_ .!ut7Ny]BPwPw i<)nWH*Pw iT A%ťt 9\.!-twg p؂t7Nĝ \ .!-JPw i+|~.u&[ىc҄JKH ݝ}ÿ]BDn>u"ӣ]Bl]_]B:O!JwӘa݃ B%G/bPw ILPw {T\_.!=fwPw y^ .ݝusIþ0]B_w]$]BDnuw9i Pw z\\A<1տ&]Bt7 1)C%D Jw'=twv/ up1Oyv/ u0ͧ~v u(ݝ"c"ᒮ27ϮU"yBg{]BDtw3fPw u,]BD\s\wKL.ewU.]Bdnyvկ ucL-;{č"GىB]BN<KG&uwM fPw A|`Юw2]B\vF=2A%!Lw|VRw׆K oPw #nѰ8n.!:u ?RwׇK-@%B"]ջ@%B+ݶֻA%ĂGިwK +5KEx{ؠ+]Bl=بz M`['҆Kufg>Pw 1W)4҃KxWtbe^>.!fu3Aqb&HwsX@s@%by Pw B8yv-uk=K޼@0+y+xyţyv!ou+=W~A%Cgvu3-Chapter Heading 1 $@&a$5CJ OJQJ^JjCj +Z Table Grid7:V0H@RH +Z Balloon TextCJOJQJ^JaJ@Q@b@  Body Text 3 $1$a$h4@r4 @<Header  !4 @4 @<Footer  !.)@. @< Page Number2B@2 YiD Body TextxPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$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]   DDiiil@ n , BdRjR4ub"Jh\ "#&*-/369;=>@ACEGIKPRU[]iknpsx& \ R  ~ f(,Rnjtdf6^%¿n!$%'()+,.0124578:<?BDFHJLMNOQSTVWXYZ\^jlmoqrtuvwyp| )5;O[at (4:[gkq} 5EXh}$DPVsWg*3Cq}#8HUagq_ k q ? O W g m }  $ 4 Y i O [ a x %+Q]ciuy_FFFFFFFFFFFFFFFFG,G,G,G,FFFFFFG,G,G,G,G,G,FG,FG,FG,FG,FG,G,FFFFG,G,G,G,G,G,G,G,G,G,FFFFFFFFFF]dfl!l,b$Ugū.2Yq4@ (  ~  S .A DPH-clrC"?b  3 1#" `? B S  ?t|t Text1Text2Text32Text3Text9Text35Text34Text36Text27Text25Text26qPu)VR b;hdE%F%G%H%I%J%K%L%M%N%O%P%Q%R%S%T%U%V%W%"ggn      !&&mrr   9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType9*urn:schemas-microsoft-com:office:smarttagsState /0235689;<0235689;<$*2FGG3~&UhlK   > [ m w w ?Qf /002335689;<t~GG /002335689;<~_8zf#zfoOzfhOzf_Zzf.jo~)mO)nz:Rhh^h`B*OJQJo(hh^h`B*OJQJo(hh^h`B*OJQJo(hh^h`B*OJQJo(hh^h`B*OJQJo(hh^h`OJQJo(hHn^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hH ^`OJQJo(4 h^h`OJQJo(4 88^8`OJQJo( ^`OJQJo(- ^`OJQJo( pp^p`OJQJo(   ^ `OJQJo( @ @ ^@ `OJQJo(   ^ `OJQJo(h88^8`CJOJQJo(hHhpp^p`OJQJ^Jo(hHoh@ @ ^@ `OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHhPP^P`OJQJ^Jo(hHoh  ^ `OJQJo(hH~)m.j)nz0_Z#oOhO_8@6        P~r         R\ @r u A L i h nboR'52$F @%X%@&H&f& C(X+-I/X/n//D6e78@9=-:s==x=.AxAKB_dBfDYiD^*FH{uILL Nv NS9TIbTr#U*7U/WsW!Y;RY+Z8\]q]R_xc3efOflUg_5hi{ik:kekyvl`mopfr+ts9u?Rv+yzR{Fh8\IE"$EO7(k6hbCQAAAaa3zyRS|4f*&EP>-Ifs6YK`F\Q 8p52u.i% w!(j _a01tYG#:')x x@<02@ }}}}}}~~~ ~ \ \ @ (@8@Unknown G*Ax Times New Roman5Symbol3. *Cx Arial9Garamond5. .[`)Tahoma;Wingdings?= *Cx Courier New9 WebdingsA$BCambria Math"1h''ăO (O (!=er4%% 3QHX ?_5h*!xx 1User ID Request + Confidentiality Agreement FormsClaudia Drenan Nina Brown,        Oh+'0 $0 P \ h t4User ID Request + Confidentiality Agreement FormsClaudia Drenan,UserIDRequestConfAgreementForm01-08-13.dot Nina Brown2Microsoft Office Word@F#@4I@ds @ds O՜.+,0 hp|  NSB( % 2User ID Request + Confidentiality Agreement Forms Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"$%&'()*/Root Entry FPJ$1Data 1TableS>WordDocumentSummaryInformation(DocumentSummaryInformation8#CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q