37 Pa. Code § 171.153 - Form for notice of appearance

The following is the form for notice of appearance:

COMMONWEALTH OF

PENNSYLVANIA

ARBITRATION PANELS FOR

HEALTH CARE

:
vs.	:	No.
:	County:
:	(Form of action)

NOTICE OF APPEARANCE FOR (Party's name and designation)

Please enter my appearance in the above-captioned matter on behalf of

(Name of Party)

(Party's address)

I am authorized to accept service on behalf of said party in this matter.

(Signature)

______________

(Name)

(Firm's name)

(Address)

(Telephone number)

(Attorney certificate number)

Notes

37 Pa. Code § 171.153

This section cited in 37 Pa. Code § 171.26 (relating to notice of appearance).