EFTA Document EFTA01304176

LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-810 8 Emergency Contact Form Date: 03/19/18 Employee Name: Gael J Leatham Address: 10-9 Estate Manendahl Phone: Title / Position: Landscapi,.g Cell: Start Date: Date of Birth E-Mail: Marital Status: Single License: 1 ergency Information: Allergies or Health Concerns: Blood Type: O+ Current Medication: Doctor's Name: Doctor's Name: Phone: Phone: LL LL 2 C In case of an Emergency, Please contact : Name Kendra Daniel me Sophie Happar Relationship Girlfriend Relationship Phone Sister Phone This Information is for your safety and the safety of others EFTA01304176