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9/27/2023 9:22:31 AM Page 21 of 21 <br />Complete the below information if adding, removing or editing a GEMS user(s) <br />GEMS User 1 <br />Add/Change {{[]c11_es_:signer1}} Remove Access {{[] c12_es_:signer1}} <br /> <br />Add as a media contact? Yes {{[]c1_es_:signer1}} No{{[]c2_es_:signer1}} <br />{{UserName1_es_:signer1 }} {{UserTitle1_es_:signer1 }} <br />Name Job Title <br />{{UserEmail1_es_:signer1 }} {{UserPhone1_es_:signer1 }} <br />Email address Phone number <br />GEMS User 2 <br />Add/Change {{[]c13_es_:signer1}} Remove Access {{[]c14_es_:signer1}} <br /> <br />Add as a media contact? Yes {{[]c3_es_:signer1}}No {{[]c4_es_:signer1}} <br />{{UserName2_es_:signer1 }} {{UserTitle2_es_:signer1 }} <br />Name Job Title <br />{{UserEmail2_es_:signer1 }} {{UserPhone2_es_:signer1 }} <br />Email address Phone number <br />GEMS User 3 <br />Add/Change {{[]c15_es_:signer1}} Remove Access {{[]c16_es_:signer1}} <br /> <br />Add as a media contact? Yes {{[]c5_es_:signer1}}No {{[]c6_es_:signer1}} <br />{{UserName3_es_:signer1 }} {{UserTitle3_es_:signer1 }} <br />Name Job Title <br />{{UserEmail3_es_:signer1 }} {{UserPhone3_es_:signer1 }} <br />Email address Phone number <br />GEMS User 4 <br /> Add/Change {{[]c17_es_:signer1}} Remove Access {{[]c18_es_:signer1}} <br /> <br />Add as a media contact? Yes {{[]c8_es_:signer1}}No {{[]c7_es_:signer1}} <br />{{UserName4_es_:signer1 }} {{UserTitle4_es_:signer1 }} <br /> <br />Name <br /> <br />Job Title <br />{{UserEmail4_es_:signer1 }} {{UserPhone4_es_:signer1 }} <br />Email address Phone number <br />GEMS User 5 <br />Add/Change {{[]c19_es_:signer1}} Remove Access {{[]c20_es_:signer1}} <br /> <br />Add as a media contact? Yes {{[]c9_es_:signer1}}No {{[]c10_es_:signer1}} <br />{{UserName5_es_:signer1 }} {{UserTitle5_es_:signer1 }} <br />Name Job Title <br />{{UserEmail5_es_:signer1 }} {{UserPhone5_es_:signer1 }} <br /> <br />Email address <br /> <br />Phone number <br />Form completed by: {{Sig_es_:signer1:signature}} Date: {{Dte1_es_:signer1:date}} <br /> <br />As a signatory I hereby authorize the listed individual(s) to represent and have GEMS user access. <br /> {{Sig_es_:signer2:signature}} {{Name1_es_:signer2:fullname }} <br />Signature Name <br /> {{Dte2_es_:signer2:date}} Grant Director <br />Date Title