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Participant Information

Participant Name*

First Middle Last

Date Of Birth*

Race

Sex

Height

Weight

Mobile Phone*

Email*

Work Days

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

From Time

To Time

Home Address*

Street Address Address Line 2 City State ZIP Code

Secondary Point of Contact

First Name*

Middle Name

Last Name*

Mobile Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Employment Information

Employer Name

Work Phone

Address

Street Address Address Line 2 City State ZIP Code

Jurisdiction Information

Jurisdiction Information*

Upload the Bond Order

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Accepted file types: jpg, gif, png, pdf, docx, doc, Max. file size: 40 MB, Max. files: 4.

You agree to pay the applicable fees for the Services when due plus all related taxes. All applicable taxes are calculated based on the billing information you provide us at the time of purchase. Unless otherwise denoted, all fees are assessed in U.S. dollars.

You also agree that Talitrix and its third-party service providers providing payment processing services may store your payment information. You authorize us to charge your payment method (e.g., credit card, ACH, etc.) for subsequent recurring charges for the Services that you purchase or use. If the payment method you provide us reaches its expiration date and you do not edit the applicable information or cancel such Service, you authorize us to continue billing that payment method and you remain responsible for any uncollected amounts. If you purchase a subscription to a Service, you will be billed for your first month immediately upon purchasing or upgrading to a subscription account.

Unless otherwise set forth on an applicable ordering document incorporating these Terms, the Services are billed in advance on a monthly basis and are non-refundable.

I agree to the Terms of Service

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