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IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA

KEITH STILL, on behalf of himself and all persons similarly situated,

Plaintiff, v.

MANHEIM TOWNSHIP.

Defendant.

: : : : : : : : : :

Civil Action No.: Jury Trial Demanded

OPT-IN CONSENT FORM

Pursuant to 29 U.S.C. § 216(b), the undersigned consents to become a party plaintiff in the above-captioned Fair Labor Standards Act case, to be bound by judgment of the court as to all issues, and to be represented by Jennings Sigmond, P.C.

___________________________ Signature

___________________________ Name

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