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completed_waiver.xml
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completed_waiver.xml
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<DocuSignEnvelopeInformation xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://www.docusign.net/API/3.0">
<EnvelopeStatus>
<RecipientStatuses>
<RecipientStatus>
<Type>Signer</Type>
<Email>tim@mit.edu</Email>
<UserName>Tim Beaver</UserName>
<RoutingOrder>1</RoutingOrder>
<Sent>2018-11-10T18:40:43.99</Sent>
<Delivered>2018-11-10T18:40:47.92</Delivered>
<Signed>2018-11-10T18:41:06.093</Signed>
<DeclineReason xsi:nil="true"/>
<Status>Completed</Status>
<RecipientIPAddress>127.0.0.1</RecipientIPAddress>
<ClientUserId>1</ClientUserId>
<CustomFields/>
<TabStatuses>
<TabStatus>
<TabType>FullName</TabType>
<Status>Signed</Status>
<XPosition>43</XPosition>
<YPosition>1100</YPosition>
<TabLabel>Releasor's Name</TabLabel>
<TabName/>
<TabValue>Tim Beaver</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
</TabStatus>
<TabStatus>
<TabType>EmailAddress</TabType>
<Status>Signed</Status>
<XPosition>456</XPosition>
<YPosition>1100</YPosition>
<TabLabel>Releasor's Email</TabLabel>
<TabName>EmailAddress</TabName>
<TabValue>tim@mit.edu</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
</TabStatus>
<TabStatus>
<TabType>SignHere</TabType>
<Status>Signed</Status>
<XPosition>50</XPosition>
<YPosition>937</YPosition>
<TabLabel>Releasor Signature</TabLabel>
<TabName>Signature of participant</TabName>
<TabValue/>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Signed</Status>
<XPosition>456</XPosition>
<YPosition>1179</YPosition>
<TabLabel>Address</TabLabel>
<TabName>Releasor's home address</TabName>
<TabValue>742 Evergreen Terrace</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<ValidationPattern/>
<CustomTabType>Text</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Signed</Status>
<XPosition>456</XPosition>
<YPosition>1300</YPosition>
<TabLabel>Medical Insurer</TabLabel>
<TabName>Your health insurance (e.g. Blue Cross)</TabName>
<TabValue>Aetna</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<ValidationPattern/>
<CustomTabType>Text</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Signed</Status>
<XPosition>456</XPosition>
<YPosition>1381</YPosition>
<TabLabel>Medical Policy Number</TabLabel>
<TabName>Your health insurance policy number</TabName>
<TabValue>Unsure</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<ValidationPattern/>
<CustomTabType>Text</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Signed</Status>
<XPosition>43</XPosition>
<YPosition>1300</YPosition>
<TabLabel>Emergency Contact</TabLabel>
<TabName>Name of individual that should be contacted in case of an emergency</TabName>
<TabValue>Julius Hibbert</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<OriginalValue>Julius Hibbert</OriginalValue>
<ValidationPattern/>
<CustomTabType>Text</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Signed</Status>
<XPosition>43</XPosition>
<YPosition>1381</YPosition>
<TabLabel>Emergency Contact Relation</TabLabel>
<TabName>(sibling, spouse, parent, etc.)</TabName>
<TabValue>Physician</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<OriginalValue>Physician</OriginalValue>
<ValidationPattern/>
<CustomTabType>Text</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Signed</Status>
<XPosition>456</XPosition>
<YPosition>1012</YPosition>
<TabLabel>Phone number</TabLabel>
<TabName>Releasor's Phone Number</TabName>
<TabValue>617-555-1234</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<OriginalValue>617-555-1234</OriginalValue>
<ValidationPattern/>
<CustomTabType>Number</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Signed</Status>
<XPosition>43</XPosition>
<YPosition>1462</YPosition>
<TabLabel>Emergency Contact's Phone</TabLabel>
<TabName>Phone number of your emergency contact</TabName>
<TabValue>800-555-1234</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<OriginalValue>800-555-1234</OriginalValue>
<ValidationPattern/>
<CustomTabType>Number</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Signed</Status>
<XPosition>900</XPosition>
<YPosition>1533</YPosition>
<TabLabel>Affiliation</TabLabel>
<TabName>Non-affiliate</TabName>
<TabValue>X</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<OriginalValue>X</OriginalValue>
<CustomTabType>Radio</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>DateSigned</TabType>
<Status>Signed</Status>
<XPosition>43</XPosition>
<YPosition>1183</YPosition>
<TabLabel>Date Signed</TabLabel>
<TabName>DateSigned</TabName>
<TabValue>11/10/2018 | 6:41:06 PM EST</TabValue>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Active</Status>
<XPosition>900</XPosition>
<YPosition>1358</YPosition>
<TabLabel>Affiliation</TabLabel>
<TabName>MIT grad student</TabName>
<TabValue/>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<CustomTabType>Radio</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Active</Status>
<XPosition>900</XPosition>
<YPosition>1393</YPosition>
<TabLabel>Affiliation</TabLabel>
<TabName>Non-MIT undergrad</TabName>
<TabValue/>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<CustomTabType>Radio</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Active</Status>
<XPosition>900</XPosition>
<YPosition>1427</YPosition>
<TabLabel>Affiliation</TabLabel>
<TabName>Non-MIT grad student</TabName>
<TabValue/>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<CustomTabType>Radio</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Active</Status>
<XPosition>900</XPosition>
<YPosition>1462</YPosition>
<TabLabel>Affiliation</TabLabel>
<TabName>MIT affiliate</TabName>
<TabValue/>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<CustomTabType>Radio</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Active</Status>
<XPosition>900</XPosition>
<YPosition>1497</YPosition>
<TabLabel>Affiliation</TabLabel>
<TabName>MIT alum</TabName>
<TabValue/>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<CustomTabType>Radio</CustomTabType>
</TabStatus>
<TabStatus>
<TabType>Custom</TabType>
<Status>Active</Status>
<XPosition>900</XPosition>
<YPosition>1322</YPosition>
<TabLabel>Affiliation</TabLabel>
<TabName>MIT undergrad</TabName>
<TabValue/>
<DocumentID>1</DocumentID>
<PageNumber>1</PageNumber>
<CustomTabType>Radio</CustomTabType>
</TabStatus>
</TabStatuses>
<RecipientAttachment>
<Attachment>
<Data>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</Data>
<Label>DSXForm</Label>
</Attachment>
</RecipientAttachment>
<AccountStatus>Active</AccountStatus>
<FormData>
<xfdf>
<fields>
<field name="FullName">
<value>Tim Beaver</value>
</field>
<field name="EmailAddress">
<value>tim@mit.edu</value>
</field>
<field name="Address">
<value>742 Evergreen Terrace</value>
</field>
<field name="Medical Insurer">
<value>Aetna</value>
</field>
<field name="Medical Policy Number">
<value>Unsure</value>
</field>
<field name="Emergency Contact">
<value>Julius Hibbert</value>
</field>
<field name="Emergency Contact Relation">
<value>Physician</value>
</field>
<field name="Phone number">
<value>617-555-1234</value>
</field>
<field name="Emergency Contact's Phone">
<value>800-555-1234</value>
</field>
<field name="Affiliation">
<value>Non-affiliate</value>
</field>
<field name="DateSigned">
<value>11/10/2018 | 6:41:06 PM EST</value>
</field>
</fields>
</xfdf>
</FormData>
<RecipientId>ffe32e5b-4b61-4fb6-b0f1-20e0f33d2bda</RecipientId>
</RecipientStatus>
<RecipientStatus>
<Type>CarbonCopy</Type>
<Email>mitocdesk@gmail.com</Email>
<UserName>MITOC Desk</UserName>
<RoutingOrder>3</RoutingOrder>
<Sent>2018-11-10T18:41:06.907</Sent>
<DeclineReason xsi:nil="true"/>
<Status>Completed</Status>
<RecipientIPAddress/>
<CustomFields/>
<AccountStatus>Active</AccountStatus>
<RecipientId>0090c446-1f08-4f89-ab06-243d943b946f</RecipientId>
</RecipientStatus>
</RecipientStatuses>
<TimeGenerated>2018-11-10T18:41:26.3138245</TimeGenerated>
<EnvelopeID>aa8ba71c-dbd5-4575-b82d-0941c67e90bd</EnvelopeID>
<Subject>Please sign the MITOC Liability Waiver</Subject>
<UserName>MITOC</UserName>
<Email>outing-club-docusign-api@mit.edu</Email>
<Status>Completed</Status>
<Created>2018-11-10T18:40:43.363</Created>
<Sent>2018-11-10T18:41:06.937</Sent>
<Delivered>2018-11-10T18:41:06.937</Delivered>
<Signed>2018-11-10T18:41:06.937</Signed>
<Completed>2018-11-10T18:41:06.937</Completed>
<ACStatus>Original</ACStatus>
<ACStatusDate>2018-11-10T18:40:43.363</ACStatusDate>
<ACHolder>MITOC</ACHolder>
<ACHolderEmail>outing-club-docusign-api@mit.edu</ACHolderEmail>
<ACHolderLocation>DocuSign</ACHolderLocation>
<SigningLocation>Online</SigningLocation>
<SenderIPAddress>127.0.0.1</SenderIPAddress>
<EnvelopePDFHash/>
<CustomFields>
<CustomField>
<Name>Enter Sender Name</Name>
<Show>True</Show>
<Required>True</Required>
<Value>mitoc-owner@mit.edu</Value>
</CustomField>
<CustomField>
<Name>AccountId</Name>
<Show>false</Show>
<Required>false</Required>
<Value>12665596</Value>
<CustomFieldType>Text</CustomFieldType>
</CustomField>
<CustomField>
<Name>AccountName</Name>
<Show>false</Show>
<Required>false</Required>
<Value>Massachusetts Institute of Technology</Value>
<CustomFieldType>Text</CustomFieldType>
</CustomField>
<CustomField>
<Name>AccountSite</Name>
<Show>false</Show>
<Required>false</Required>
<Value>na2</Value>
<CustomFieldType>Text</CustomFieldType>
</CustomField>
</CustomFields>
<AutoNavigation>true</AutoNavigation>
<EnvelopeIdStamping>true</EnvelopeIdStamping>
<AuthoritativeCopy>false</AuthoritativeCopy>
<DocumentStatuses>
<DocumentStatus>
<ID>1</ID>
<Name>MITOC Liability Waiver.pdf</Name>
<TemplateName>MITOC Liability Waiver</TemplateName>
<Sequence>1</Sequence>
</DocumentStatus>
</DocumentStatuses>
</EnvelopeStatus>
<TimeZone>Eastern Standard Time</TimeZone>
<TimeZoneOffset>-5</TimeZoneOffset>
</DocuSignEnvelopeInformation>