Authorization, Waiver, And Release

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This form is reserved for those who require ARRT to communicate with their legal counsel regarding a
current ethics investigation. Signing below waives and holds ARRT harmless from any legal action for
releasing information to the assigned party.
Directions:
Print this document.
Print attorney’s name and firm on the blank line within the Authorization, Waiver, and Release form.
Sign, print your legal name, and date the form.
Complete the fax cover sheet. Be sure to include the required contact information for your attorney.
Fax the cover sheet and signed form to ARRT’s Ethics Requirements Department at (651) 687-0449.

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