South Central Los Angeles Regional Center

213-744-7000

Print Document

When you click Print below we will prepare a printable document for you. It will automatically download when it's ready.

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You can fill in the document online and then click the print icon and all of your information will be populated in the printable document, saving you time later.

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Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

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