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<br />AUTHORIZATION TO APPEAR AT PRE-HEARING CONFERENCE <br />ON BEHALF OF A PARTY <br /> <br />(Please Type or Print the Requested Information) <br /> <br />SIGNATURES MUST BE IN BLUE INK <br /> <br /> <br />I , <br />(person’s name) (title, if applicable) <br /> <br />of (name of company, association, <br />organization, etc., if applicable) <br /> <br />hereby delegate to , <br />(person or entity’s name) <br /> <br />the right to appear on behalf of <br />(person, company, association, organization, etc.) <br />at the Pre-hearing Conference. <br /> <br /> <br />SIGNED AND DATED THIS DAY OF , . <br /> <br /> If corporate attest <br />(seal) Authorized Signature (must be signed in blue ink) <br /> <br />Title: <br /> <br />State of ) <br />) <br />County of ) <br /> <br />The forgoing instrument was acknowledged before me this day of , <br /> by as of . <br /> <br /> <br />Notary Public <br />My commission expires: <br /> <br /> <br />SIGNATURES MUST BE IN BLUE INK