JFIFC    $ &%# #"(-90(*6+"#2D26;=@@@&0FKE>J9?@=C  =)#)==================================================" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?#1Rni#*@9V38AQ4xҲ)L$nOz~U :Vv&|Aq3Pp}E:v#jQӐmAO=:PҐ`q) JavXT3M-đw`HڛU.$RZkDd2@Cڂ#'A1=S}.Fɫ,*6Ojɚ*V^EH< `bTB8SH&&NEfixZM۹Zn_zT:7C5< wоõ ?ʜ3sP=1Nzt^8i v@ THbּW$W wEpFʠgzרx6ie̗Es#ŽyVsX͆WXc,jM\"ܬu> Ҭ$[RGq:ŝFK+{#B}UkZh%hEsB$ 2{ya.5HvAKt˸'Ttzm+\gH[\rUB ;X<_źLjw7S!pA [6 W 8m܌uUFl@Vc9IEqeh T0QKV9LcqO<ܚ xuy-#xn?@!XP ҳrqJ,u tC  ҼTwm")+ar#ͧGqldM ٌku0ڥX5(b/o<}+=Ժ[cGנ*=*7EMf ^(:giҴyV`4q;Uu+uYQ%z9WPM2q 23ɩФƝRbFU>b2p}˝jvګ(HШ9Ҧ9|Nт޴1Gp(8* ݽiyN1H=0N@@T}j2=7ҊQL)w)'LJE@ϵJ=*ΡgǷ֬M2ЩP"A)0.Oݪ0)gjPǡxO E w ~TSWڠ5&mYFnz4C55ͬZ̭)as0!G8UQɯT£+ɨj>NZK hUAkkEg+JŏIa R7혟]9g۵!>݅pt˖_ IRqNխL}G 2Ђ2)|:S L?壟0} *v0iNڐP1Gj67p*ed:sߟZ9+᫬ gbŅKq֛bl-RaFU˜KwzI%f$BJϿ{.%ºmW'"4=n.l#{JՇzĈx €^ȍIE &q?"guvּ>(>&[kF(XHG^ULӰ1Y#𢕆dEʌ ?SS"\ o%p{C@1Ur>y $tEVGu_G7szM.t?'w>D,\^a?c'ڸؾ!M4q38y1@ Ggv,ry$\g)5JCwvu TG>v5m(zsw1܂D.ΝhGAqpĊ1Tm) YURBCRǧj`JNXrOZyWJ#U1{ַuJ׮3^d{{*ȨeW9U6/@ ?tZf^1bg\]ޛaB,֔#36E#o9)CT^zY%*`I'VF,jEQNjl.u;m˝D)JE|OX+E#*~ >;ӪyM=Sxbee10v$vѺ4& ckk:O3Wjm 1?!Njt7{aP̓3F\9׮:un#UTp0Wr0O#hEgyoZVﴔ2kxUkD'YE6؈N@ه`F{gq$"vOl26+~0b=*X_x{U?RF,`2?4(y6+Y{2HP66ָuD`yr0={zgKa2ִtDONJ2nbB?΋Y sSZ^;Vc|WfźU ,D*[^w[]muVZ\ 6!e;CXR4*Y.j;}kQRuvah(<9xEUX5ңX̄t=Lub7r߄Z+{uqSyU_sK!%~Ҵlu9n5;I-bMal0Y+"W[1-x)˙&$hc(BK@d%ea?%3G6 \+:v2w2Y%&7O)MHvTQR3i762[]ZaT`+5 )es)u{#37IN'D#u΋g$qV.;*VQJ.ewEMadǚհT7TV"d_? ުQal?tQL ĺVl+Quy('q V~AUn46no-|ɶ'q:\,E*oC;uk2au*F\\y=nk,-m7[Yn-7Y1糎G@w+U**2UvOZ'r8pjI,}9Oa1S$nЖ>f4-6 (0صwЎ€"*Xn9aLe5 TE99al9+ȮMt^ *+`u NimpB<ڜ⤎%e隧}"[.f=#;yi.܃+3V%1sq&uOd β%IO'=VJ=‹,:TW sֺx:{b- iHT'vbG羏92 |/+43coҸ(8R7V2dt?m+O"-  rIb#ml82 \WKٓƨ$FOZ^x~0!7ÚIELe8Z[>r8alrR " C`p 1!}sSXҔLgҥ d~TdTpjYi3m6G|ӣi3U֝Zfޅ>?o83*=/zT|<ț!LZ9N,DŽ:Vcc9E ٴEX?c+ Ibxv'̇Wܛ}=fF4Q"Z' p2g%%`I|K_6/ kÏQYJ\18Zs|Is}隂]Hɒ8ҰS-bpIq]Z3*<=z+ 6!{k$4%!v8>լŧͩ*hXPe`P<9{>,ʡ&U y}+K5ɺfB7/u]ZMkK0ڒڲMb!RyO[ 'I?^l~{w،xqm]N}KLeԥtSO ~o[JpSќߎn\+m"2CwO;+nؼ?EpTɻ d#N1qercf[yຉXw@`)f }sIqm1Ӷ[Xғ~ъw.Sޏ$1mt,\ZbiWIaOj%4䅀ZoիHwG{>Z*qg3ji"[Wc5zM6KXpLl> [!zbh5M*7EPwrsUE=9vݧ.- 3nct蠑D*_==C`f-J3zըF1J4FeiZ$m4.2qsZwIl+[}ĩ}?(#M:EĮT<5=ƬmsioǟJ4sM͞[(WSi Xe¸EF8˗Q}sȪ^+ֳM.dlE<3kȫ1xGHgST2^asV[Dc9`y޳|?⫋^Gkg,uCjӍ9&KY$-'`Z[oì-mpuW-^0QK=_\%8.won>fmN@gi| ަԭu 鰽F1X;QxVZ6c2g'2ds vuzmԾimTgM<Ͻjgmr'{pkm$x`[xAԢqwfz>eEr:*B cL[fLguu%<1<K34Pd9*GyƢ4^GaåxSlmm!*±*K J˂:s^9\P+ּ2x{k20(\Mmmh_*ǁzS\ %ʇh3,Hvz^e{&arq}8Lq>[3Mi #n0q4U /W=*{[{F9qŗ7&@2NGy-οŎ:WUw"}`1xw~89ͩ+iEm=ZxW̬4 yƱu8茖&w\ʑֳ[2, mSXiiiV S #n Ya}ivBZ=75$$cj7wbuۻy,n^z׫rA0\pqҲSz˛9L]  ӾeL+<aATKt3m=8 wFҪҌTixݾU؜ECqt,>cmJRW>_=5@gb\̶1If &o-pJ b@b<(jO皵BPw<•h_B$Mx18=@V}]blU\֭υi/l'ܭnF6PcYv$ެKm cצk8y*snz֗&5S!,2ڱ

tmheGLqWLJ\`ecQU]iԴ ZU&(iL<i5$Hřd0.F vy淴&JtV3fe*G/Lٰv+4^rgBGn#UjjY=IZGq'VN&N_nC!A4ťI22MMsWR-pڷ?t7S{+'Eu8|n'J{RWdM 0^< g~ N_َǨjƧN۳tH"׼2$hjV9Z$n35\q޺xtxQ'D22̢s~qj9[StL~Uݦq=slwdv=}kN+%3E%V.1cx"3]F:+ۗ|bʬ8&'^vtJvGGcJ><ێE;8#85=r?:\!q{H3iph=Izs& (уhڔ}M4uSs@ FK!hORchϭ(6vrK%"7ﲞ[V! @&xz稢QNRE$!JhZS֊(=)Ҋ) Jz(hFQL~Q@1QM?zE)'ğ*'y0d~)󸌀xW=i}MUѣ<+Pڎlp_*@u5AA==֒j:f[I$? /3i-ۊ`e($
Clinic Information
Preferred Clinic Dates
(Make Two Choices)
First Choice (Date):

Second Choice (Date):
Second Choice Day(s) of the Week:
Nearest Airport Airport Name: