Addresses for Notice. Submitter is required to provide information in the Primary Contact fields below unless otherwise noted. Pursuant to Section 18, Notifications will not be sent via facsimile; however, please feel free to provide this information. Submitter Address for Notice Primary Contact Alternate Contact Not required Name Title Organization Address City, State Zip Phone Fax (not required) E-mail Attn: Legal Team 0000 Xxxx Xxxxxxx Xxxxxx Xxxxxxx, XX 00000-0000 Phone: 000-000-0000 Email: XXXXXxxxx@XX.Xxx Please provide contact information for the following staff members at your organization. Each field must be filled even if one person occupies more than one role. All fields must be completed or the processing of your Participation Agreement will be delayed.
Appears in 5 contracts
Samples: Nc Hiea Participation Agreement, Nc Hiea Participation Agreement, Nc Hiea Participation Agreement
Addresses for Notice. Submitter is required to provide information in the Primary Contact fields below unless otherwise noted. Pursuant to Section 18, Notifications will be sent to the contacts below concerning this Agreement, including the need for amendments. Notifications will not be sent via facsimile; however, please feel free to provide this information. Submitter Address for Notice Primary Contact Alternate Contact Not required Name Title Organization Address City, State Zip Phone Fax (not required) E-mail Attn: Legal Team 0000 Xxxx Xxxxxxx Xxxxxx Xxxxxxx, XX 00000-0000 Phone: 000-000-0000 Email: XXXXXxxxx@XX.Xxx Please provide contact information for the following staff members at your organization. Each field must be filled even if one person occupies more than one role. All fields must be completed or the processing of your Participation Agreement will be delayed.
Appears in 2 contracts
Samples: Nc Hiea Participation Agreement, Nc Hiea Participation Agreement