BIOGRAPHICAL INFORMATION. Information regarding the Claimant.
BIOGRAPHICAL INFORMATION. 75-word biography that highlights your background as relevant to this proposal content.
BIOGRAPHICAL INFORMATION. Date: Therapist here to see: CLIENT NAME: DOB: AGE: Sex: MARITAL STATUS: single married divorced separated widow minor Preferred Pronoun: ADDRESS: CITY: STATE: ZIP: Home # Preferred Phone #: Cell #: May we leave a message: Work #: List Family Members / Ages: / / / Our system generates automatic reminder calls/texts to your preferred # Desired Format: If you have any special direction concerning mail delivery to your stated address please note here: EMPLOYER: OCCUPATION/POSITION: EMERGENCY CONTACT: RELATIONSHIP TO CLIENT: EMERGENCY CONTACT PHONE #: If there should be a need for us to contact your emergency contact person, we will only disclose any information that is related to the emergency situation. Please initial here that you understand this. I understand that in an emergency situation, relevant information will be disclosed initial If client is a minor, please complete the following: WHO DOES MINOR RESIDE WITH: RELATIONSHIP TO CLIENT: NAME OF RESPONSIBLE PARTY: SCHOOL/GRADE: / How did you hear about us? website friend relative school physician other:
BIOGRAPHICAL INFORMATION. Xx. Xxxxxxxx is the founding shareholder of Xxxxxxxx, Wall & Xxxxxx, P.C., a Fort Worth, Texas law firm which represent individuals, closely held and family businesses, professional practices and charitable organizations within its areas of legal practice. Xx. Xxxxxxxx was born in Fort Worth, Texas on October 2, 1943. He earned a B.A. from Baylor University and his X.X. from Baylor University School of Law. He earned his LL.M. in Taxation from University of Miami, Florida. Additionally, he was a Captain in JAGC, USAF, 1970-1975. Xx. Xxxxxxxx was admitted to practice law in Texas in 1969 and is Board Certified in Estate Planning and Probate Law (Texas Board of Legal Specialization). He is a member of the American Bar Association; State Bar of Texas and its Real Estate, Probate and Trust Law Section (Real Estate, Probate and Trust Law Council, 1993-1996); Tarrant County Bar Association (Director, 1987-1989); Tarrant County Probate Bar Association; Fort Worth Business and Estate Council (Chair, 1992-1993); and a Fellow of the American College of Trust and Estate Counsel.
BIOGRAPHICAL INFORMATION. (a) Notwithstanding anything herein to the contrary, Producer shall have the right to authorize one or more radio and/or television excerpts of the Play, not exceeding fifteen (15) minutes each, for the purpose of advertising, promoting, exploiting and publicizing the theater industry, performances of the Play, any person performing in the Play and for use on awards programs (including, but not limited to, the Xxxxxxxxxx Xxxxx Award program), without any additional approval by, or payment to, the Authors, provided that Producer receives no compensation therefrom other than reimbursement of out-of-pocket expenses and, provided further, that Authors shall have right of prior written approval of any change to be made to the script in an extract produced under the control of the Producer, such approval not to be unreasonably withheld.
BIOGRAPHICAL INFORMATION. 7. I am a partner with the firm of Xxxxxx Xxxxxxx & Associates LLC. I submit this declaration in support of Plaintiffs’ motion for preliminary approval of settlement in the above- entitled action. I am a member in good standing of the Missouri Bar and I have never been the subject of any disciplinary proceeding. In addition to being admitted to Missouri, I am also licensed to practice in the States of Illinois and Kansas. Furthermore, I am admitted to practice before The United States Court of Appeals for the Eighth Circuit, the United States Court of Appeals for the Ninth Circuit, the United States Court of Appeals for the Tenth Circuit, the United States District Court for the Northern District of Illinois, the United States District Court for the Southern District of Illinois, the United States District Court for the Eastern District of Missouri, the United States District Court for the Western District of Missouri, the United States District Court for the District of Kansas, the United States District Court for the Southern District of Texas, the United States District Court for the Northern District of Texas, the United States District Court for the Eastern District of Michigan and the United States District Court for the District of Colorado.
BIOGRAPHICAL INFORMATION. A biography (approved, if contractually ------------------------ required, by the subject of the biography) of each of the principal players, individual producer(s), director and, upon the request of Fox, if available a biography of the writers and of each of the key technical personnel; provided, however, that if guild requirements or other applicable Law requires a writer biography, then Saban shall so provide.
BIOGRAPHICAL INFORMATION. A. Name, Address and Birthdate: Name: (Please print) Address: Birth Date:
BIOGRAPHICAL INFORMATION. Biographical information of each competitor, including the coach, must be completed and returned to the Secretariat, World Curling Federation by email. These forms should be checked by a national official to ensure the information is relevant, and confined to factual details. Please note these should be completed electronically (handwritten biographies will be rejected) and returned as a word document. Team Photograph The WCF and the Host Committee request that each team provides two copies of a colored photograph (one picture front facing, one picture back facing showing the players’ names on their uniforms) according to the following guidelines: All players must be wearing the tops of their team uniform either the dark or light colors. Team photographs must be taken in front of a neutral background, such as a solid colored wall. Images must be at least 500KB in size and in a digital format (.jpg file) Please also enclose athletes’ names (FIRST NAME FOLLOWED BY FAMILY NAME) either typed or clearly printed. Team Photographs should be submitted to xxxxxx.xxxxxxx-xxxxxxx@xxxxxxxxxxxx.xxx by 01 April 2017 or earlier if available. Please find below an example of the team photographs: EUROPEAN CURLING CHAMPIONSHIPS C-Division Andorra 2017 Registration Form/Release Agreement MEMBER ASSOCIATION: I certify that the following will represent the above Member Association in the European Curling Championships C-Division, Andorra 2017, and that each is a member in good standing and eligible under the Rules of the World Curling Federation to represent their Association. President’s/Secretary’s Name: Signature: Team Contact Name: Email Address: (Person contactable onsite at events) Team Order Family Name First Name Please indicate position of Skip/Vice Skip Please insert the Role of 2nd & 3rd Team Official in appropriate box below Fourth Third Second First Alternate Coach 2nd Team Official 3rd Team Official Please note that permission must be requested directly from the WCF for the 3rd team official who must be a professional intended to assist the team (e.g. – doctor, physical therapist, massage therapist, physiologist, video analyst expert, etc.)
BIOGRAPHICAL INFORMATION. If you have any biographical information you would like to share with the readers of ESC! Magazine, please use the space below. Enclose additional sheets if needed. I may not be able to use all of the information provided so please understand if it is edited for space. If you enclose a photograph and want it returned, please also in- clude a SASE with enough postage and packaging to get the photo back to you unharmed. Xxxxxxx X. Xxxxxx is not responsible for damages caused to your photograph by the carrier you designate. PHOTO SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE You may also e-mail your biographical information and/or digital photograph to: xxxxxxxxxxx@xxxxxxx.xxx Thank You! SAMPLE If there is room, would you like your e-mail address included with your bio? YES / NO Please sign here if you answered 'YES' to include your e-mail address. Your signature verifies consent. BIO Page Form #ESCREL-BIO Rev. II/09
