Practice Roster Attestation Form
Please complete this form to attest to the accuracy and completeness of your practice roster.
Full Name of Attestor
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization / Team Name
*
Roster Period (Start and End Dates)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please confirm the following statements regarding your practice roster:
*
I confirm that the roster is accurate and up to date.
All listed members are currently active and participating.
No unlisted individuals are participating in practice activities.
Other (please specify)
By signing below, I attest that the information provided above is true and complete to the best of my knowledge.
*
Submit Attestation
Submit Attestation
Should be Empty: