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Dependent FormGinger Hall2025-09-16T13:57:06-04:00

Dependent Form

Dependent Name #1(Required)
MM slash DD slash YYYY
This dependent is a:(Required)
Is your son or daughter still in school?
Do you have a 2nd Dependent to add:
Dependent Name #2
MM slash DD slash YYYY
This dependent is a:
Is your son or daughter still in school?
Do you have a 3rd Dependent to add:
Dependent Name #3
MM slash DD slash YYYY
This dependent is a:
Is your son or daughter still in school?
Do you have a 4th Dependent to add:
Dependent Name #4
MM slash DD slash YYYY
This dependent is a:
Is your son or daughter still in school?
Do you have a 5th Dependent to add:
Dependent Name #5
MM slash DD slash YYYY
This dependent is a:
Is your son or daughter still in school?
Do you have a 6th Dependent to add:
Dependent Name #6
MM slash DD slash YYYY
This dependent is a:
Is your son or daughter still in school?
MM slash DD slash YYYY
Consent to Electronic Signature
By selecting the "I Agree to the Consent to Electronic Signature" button or by electronically signing this document, I acknowledge and agree that:

-I am providing my electronic signature, which I intend to have the same legal effect as a handwritten signature.
-I consent to the use of electronic signatures and electronic records in connection with this agreement, transaction, or communication.
-I understand that my electronic signature is legally binding and equivalent to a manual signature under applicable laws, including but not limited to the U.S. Electronic Signatures in Global and National Commerce Act (E-SIGN) and the Uniform Electronic Transactions Act (UETA).
-I have the option to receive a paper copy of this agreement or to sign a paper version if I choose, and I may request this by contacting [insert contact information].
-I confirm that I have the necessary hardware and software to access, view, and retain electronic records and that I can access the electronic documents associated with this agreement.
-I agree that my electronic signature may be used for any documents or communications related to this transaction or agreement, as permitted by law.

-If I wish to withdraw my consent to electronic signatures or records, I understand that I may do so by contacting Ginger Nicholson, gdh@hlma.net, in writing, though this may affect my ability to participate in certain transactions or agreements.
-By providing my electronic signature, I affirm that I have read, understood, and agree to be bound by the terms of this consent and any associated agreements.

About HLMA

HLM Associates is a veteran-owned security consulting firm that provides professional security services and staff augmentation for the Department of Defense, Intelligence Community, Civilian agencies, and Private Sector Industrial Base.

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3226 Harmony Hollow Rd
Front Royal, VA 22630

contact@hlma.net
(413) 489-4562

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Website by Daor Design

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