Circle one Sample Clauses

Circle one. Please invoice No invoice needed I agree to make all payments outlined in the payment plan that I have chosen until the total balance owed to the College is paid in full. I understand that failure to pay as outlined above will result in the following: • I will be unable to register for the next semester, • Additional fees will be charged to my account, • My account may be sent to a collection agency. ____________________________________ Print Name Student Signature Date
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Circle one. Belgrade taxpayer/resident Non-Belgrade taxpayer/resident Are you a Belgrade community service or nonprofit, or RSU 18 school? Fee structure: (Circle those that apply and fill in amount) Belgrade resident/taxpayer: $50 for 2 hours $ Non-Belgrade resident/taxpayer: $100 for 2 hours $ (INCLUDES out-of-town companies and organizations) # Guests expected Total rental fee $ A separate cleaning/damage deposit check in the amount of $100 is required at the time this contract is submitted. It will be returned if the park grounds and gazebo are left in an undamaged and clean condition. We have a carry-in/carry-out trash policy. (Please write one check for the park usage fee and a second $100 check for the cleaning/damage deposit.) 2 SEPARATE checks payable to: Town of Belgrade Send to: Belgrade Community Center for All Seasons 0 Xxxxxx Xxxxx Xxxxxxxx, XX 00000 I acknowledge and agree to the following: • The Belgrade Village Green park must remain open to the public at all times. • Gatherings of more than 300 people are subject to the Town’s mass gathering ordinance requiring a permit. • The Town may prohibit a group or individual from using the Belgrade Village Green and gazebo. • This rental agreement serves as the lessee’s permit. Have it with you during your event as proof of your right to use the park grounds and gazebo during the assigned time. • Usage of the park grounds and gazebo is restricted to the hours of 8 a.m.-10 p.m. • Bookings are not accepted more than one year in advance. • Payment of the $100 cleaning/damage deposit secures reservations. Requested rentals will be held for only 48 hours without payment. • Your $100 cleaning/damage deposit will NOT be cashed unless the park grounds and gazebo are not left in the same state in which they were entered OR there is negligent damage during your rental. • Rental fees must be received at least 21 days prior to events. Cleaning/damage deposits will be refunded if event is cancelled at least 14 days prior to the event. Rental fees will not be refunded. • If the park grounds and gazebo are left in a clean, undamaged and orderly state, the cleaning/damage deposit check will be shredded (or returned to you). • The check can be returned within 14 days after the scheduled event, if requested. • All renters are responsible for any damages to the park grounds, gazebo or other park facilities during their event • If applicable, all renters must provide proof of comprehensive general liability insurance (appears on ...
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Circle one. Male / Female Home Phone Cell Phone Age Date of Birth (m/d/y) E-mail Name of school School Phone Name(s) of Parent(s)/Guardian(s)
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Circle one. If you decide to pay in equal monthly installments, your payment is due on the first day of the month. Membership Start Date: / / Membership Expiration Date: / / [c. Billing Authorization – automatic withdrawals?]
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Circle one. Please invoice No invoice needed I agree to make all payments outlined in the payment plan that I have chosen until the total balance owed to the College is paid in full. I understand that failure to pay as outlined above will result in the following: • I will be unable to register for the next semester, • Additional fees will be charged to my account, • My account may be sent to a collection agency. ____________________________________ Print Name Student Signature Date All students are required to complete (regardless of the method of payment), sign and return the Payment Agreement form by May 30, 2017. Please contact Bursar office at xxxxxxxx@xxxxxxxxxxxx.xxx or via telephone at 000-000-0000 with questions or concerns.
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Circle one. MasterCard / Visa / American Express / Diner's Club Credit card #: expiration date Name as it appears on credit card Signature: Amount: US$ Invoice: If selected, an invoice will be issued in the amount of the appropriate membership fee. DWARF Committee c/o IEEE-ISTO • 000 Xxxx Xxxx • P.O. Box 1331 • Piscataway, NJ 00000-0000, USA Phone +0.000.000.0000 • Fax +0.000.000.0000 • xxxx://xxx.<domain>.org Company Information: Company Name: Mailing Address: City, State: Postal Code: Country: URL: Primary Delegate (all notices of the Committee under this membership application shall be sent to the primary voting delegate, unless otherwise directed): Primary Contact Name: Title: E-mail: Mailing Address: City, State: Postal Code: Country: Telephone: Fax: Billing Contact and Address (if different from above) Billing Contact Name: Title: E-mail: Mailing Address: City, State: Postal Code: Country: Telephone: Fax: Alternate Company Contacts (attach additional contacts, if necessary): Alternate Company Contact Name: Title: E-mail: Mailing Address: City, State: Postal Code: Country: Telephone: Fax: MARKETING CONTACT: TECHNICAL CONTACT: Contact Name: Contact Name: Mailing Address: Mailing Address: City, State: City, State: Postal Code: Postal Code: Country: Country: Telephone: Telephone: Fax: Fax: Email: Email: DWARF Committee Membership Agreement Upon completion of the Membership Agreement, by signing below and participating in the DWARF Committee's activities, the applicant (and additional company contacts) signifies that he or she is an authorized agent of their company; is authorized to enter into this agreement on behalf of their company; has read, understands and accepts the DWARF Committee’s Operating Procedures, and the IEEE-ISTO Bylaws, as from time to time in force, and such rules and policies as the DWARF Committee and the IEEE-ISTO may from time to time adopt and/or incorporate into said documents. Membership in the DWARF Committee is contingent on continued adherence to the then-current version of the above referenced documents. Membership in the Committee does not imply that goods or services provided by a member are compliant to DWARF Committee standards. To date, DWARF Committee compliance criteria have not been determined. Each member shall provide the IEEE-ISTO with a web-ready logo and company URL for possible use to highlight support in marketing materials, trade show representation, publications, and the Committee's web site. Company Name: By (signature...
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Circle one. School: Chapel Xxxxxxxx Xxxx Second Xxxx Xxxxxxx Xxx Xxxxxxx Xxxxxxxxx Xxxxxx Lordship Circle one Grade: Pre-X X 1 2 3 4 5 6 Print Student Name Signature Date Print Parent/Guardian Name Signature Date
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