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Complete the below information if adding, removing or editing a GEMS user(s) <br />GEMS User 1 <br />Add/Change ❑ <br />Remove Access ❑ <br />Add as a media contact? <br />Yes ❑ <br />No ❑ <br />Name <br />Job Title <br />Email address <br />Phone number <br />GEMS User 2 <br />Add/Change ❑ <br />Remove Access ❑ <br />Add as a media contact? <br />Yes ❑ <br />No ❑ <br />Name <br />Job Title <br />Email address <br />Phone number <br />GEMS User 3 <br />Add/Change ❑ <br />Remove Access ❑ <br />Add as a media contact? <br />Yes ❑ <br />No ❑ <br />Name <br />Job Title <br />Email address <br />Phone number <br />GEMS User 4 <br />Add/Change ❑ <br />Remove Access ❑ <br />Add as a media contact? <br />Yes ❑ <br />No ❑ <br />Name <br />Job Title <br />Email address <br />Phone number <br />GEMS User 5 <br />Add/Change ❑ <br />Remove Access ❑ <br />Add as a media contact? <br />Yes ❑ <br />No ❑ <br />Name <br />Job Title <br />Email address <br />Form completed by: <br />Phone number <br />Date: <br />As a signatory I hereby authorize the listed individual(s) to represent and have GEMS user access. <br />Signature <br />Name <br />Date <br />Title <br />7/7/2020 2:09:47 PM 20 B-34 Page 14 of 14 <br />