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TimestampBroadband NameCityStateYour Full NameYour Full NameDate of SigningYour Phone NumberYour Email AddressEmergency Contact Person's Name
Emergency Contact Phone Number
Your Full Name (or Participant's Name, if a minor)Name of Parent/Guardian of Minor (if applicable)Date of Signing
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11/6/2020 15:59:58
Rio Grande Valley Broadband
AlbuquerqueNew MexicoSusan Ostlie Susan Ostlie11/8/2020505-228-5666susanostlie@yahoo.comBruce James Madden505-239-5556Susan OstlieNA11/8/2020
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11/7/2020 19:40:06Rio Grande BBABQNew MexicoBarbara RosensimonBarbara Rosensimon 11/7/20205206093953
brokenkneehiker@gmail.com
Glenda Muirhead 505.293.2155Barbara Rosensimon 11/7/2020
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11/7/2020 19:51:22Rio Grand ValleyAlbuquerqueNew MexicoColston ChandlerColston Chandler11/7/2020505 291-3366ccent@swcp.comAnne Strader505 259-5282Colston Chandler11/7/2020
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11/8/2020 5:40:23Marilynn SzydlowskiAlbuquerqueNew MexicoMarilynn SzydlowskiMarilynn Szydlowski11/8/20205053328018mjmazgaj52@aol.comlaurie marnell5058185116Marilynn Szydlowski11/8/1010
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11/8/2020 7:39:24
Rio Grande Valley Broadband
AlbuquerqueNew Mexico
Linda Starr and Robert Cornish
Linda Starr and Robert Cornish
11/8/2020505-489-5789lstarr509@gmail.comDylan Starr-Jenkinson 505-999-0118Linda Starr and Robert Cornish11/8/2020
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3/24/2021 21:48:44
Rio Grande Valley Broadband
AlbuquerqueNew MexicoSusan OstlieSusan Ostlie3/24/2021505-228-5666susanostlie@yahoo.comBruce Madden505-239-5556Susan Rae Ostlie3/24/2021
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3/29/2021 16:25:48
Rio Grande Valley Broadband
AlbuquerqueNew MexicoLinda J StarrLinda J Starr3/29/2021505-489-5789lstarr509@gmail.comRobert Cornish505-255-6037Linda J Starr3/29/2021
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3/29/2021 17:06:52Robert E. CornishAlbuquerqueNew MexicoRobert E. CornishRobert E. Cornish3/29/2021505-255-6037
bobcornish1@yahoo.com
Linda Starr505-489-5789Robert E. Cornish3/29/2021
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4/5/2021 21:33:42
Rio Grande Valley Broadband
AlbuquerqueNew MexicoSusan SelbinSusan Selbin4/5/2021505-242-6058sselbin@hotmail.comTom & Sue Selbin715-338-2051Susan Selbin4/5/2021
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4/6/2021 7:21:11Rio Grand ValleySanta FeNew MexicoVeronica EganVeronica Egan4/6/20219707994361canyonrat15@gmail.comKati Soleil2067783880Veronica E Egan4/6/2021
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4/6/2021 8:44:57Eva GonzalesAlbuquerqueNew MexicoEva GonzalesEva Gonzales11/30/19415053530028
evagonzalesc@gmail.com
Pilar Gigler510.584.6103Eva Gonzales4/6/2021
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4/6/2021 11:19:45Nwe MexicoAlbuquerqueNew MexicoSharon MilesSharon Miles4/6/20215056046307
sharon@seniorcareoptions.net
rene horvath505 898 2114sharon miles4/6/2021
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4/6/2021 16:37:46rio grandePlacitasNew MexicoSusan HarrelsonSusan Harrelson4/6/20219283791114suehar222@gmail.comLee Harrelson307-752-5428Susan Harrelson4/6/2021
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4/8/2021 9:18:30Rio Grande ValleyAlbuquerqueNew MexicoPamela McBridePamela McBride4/8/2021505-780-1262ebotpam@msn.comPhilip Clard505-690-1786Pamela McBride4/8/2021
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4/10/2021 22:57:27New MexicoALBUQUERQUENew MexicoAmy OstlieAmy Ostlie4/10/202115203056043aostlie1@gmail.comSusan Ostlie5052759491Amy Ostlie4/10/2021
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