LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 3 Phone: SREY E-mail: thesaintjames.group@ gmail.com Emergency Contact Form Today's Date frovet 18 Start Date: [ _— Employee Name: |Peter St Omer Date of Birth | j = — Mal Gg re ae E-mail } Marital Status: larried Title/Position {Operator Driver's License No: ee. t ———— — Allergies or Health Concerns: Blood type: ee ahi Current Medications; | ; | | Doctor's Name: / Doctor's Phone: Doctor's Name Doctor's Phone: | in case of emergency, please contact Name: Kishma . , - : . a ai . Relationship: Friend Phone:| Name: [Demir Relationship: [So Phone: This information is for your safety and the safety of others. EFTA00003065