Exclusion Form Sample Clauses

Exclusion Form. The Election Not to Participate In (“Opt Out” From) Class Action Settlement, substantially like the form attached hereto as Exhibit B, subject to Court approval.
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Exclusion Form. In the Matter of Xxxxxxx x. Xxxxxx’x, Inc. et al., U.S. District Court, Northern District of California Case No. 3:15-CV-00815-WHA IF YOU WANT TO EXCLUDE YOURSELF FROM THE CLASS SETTLEMENT IN THIS ACTION, YOU MUST COMPLETE, SIGN, AND MAIL THIS EXCLUSION FORM IN THE ENCLOSED PRE-PAID ENVELOPE, ON OR BEFORE [45 DAYS FROM MAILED NOTICE]. Print Name: Address: Signature: Mail Completed Exclusion Form by [45 DAYS FROM MAILED NOTICE] to: Simpluris, Inc. [ADDRESS] CLAIM FORMREST PERIODS In the Matter of Xxxxxxx x. Xxxxxx’x, Inc. et al.,
Exclusion Form. A valid and timely opt-out statement by a Class Member submitted to the Settlement Administrator asking to be excluded from the Settlement, as described further in Section III.9(d).
Exclusion Form. Election Not to Participate or Opt-out statement by a Class Member, as described further in Section III.9.d.
Exclusion Form. There may be clients that are not appropriate for cognitive behavioral group/individual therapy. Client excluded from this Clinical Pathway, must have an alternative approved clinical path. Please complete the following for approval if you feel your client should be excluded.
Exclusion Form. If you wish to be excluded from the Class, you must mail the request for exclusion to the Class Administrator, Simpluris, Inc., using the Exclusion Form below, so that it is postmarked no later than <DATE>: R EQUEST TO BE EXCLUDED FROM CLASS ACTION SETTLEMENT Riverside County Superior Court, case number MCC1500556 To be excluded from the class action settlement, you must complete and mail this form to the class administrator at the address below, postmarked on or before < DATE>: Name: Address: Telephone: I received notice of a settlement and I request to be excluded from the class action settlement in the above-entitled case. Dated: Mail this Form to: If you wish to object to the Settlement, you must submit the objection to the Class Administrator, Simpluris, Inc., using the Objection Form below, so that it is postmarked no later than <DATE>: Riverside County Superior Court, case number MCC1500556 To object to the class action settlement, you must complete and mail this form to the class administrator at the address below, postmarked on or before <DATE>. Name: Address: Telephone: I received notice of a settlement and I object to the class action settlement in the above-entitled case. The reasons for my objection are as follows (attach additional sheet if more space is required) Dated: Mail this Form to: License & Documentation 3/16/2018 New 2017 Yamaha YZF-R6 Motorcycles in Murrieta, CA | Stock Number: Y000710 xxxxxxxxxxxxxxxxxxx.xxx FOLLOW US | (000) 000-0000 Supersport • New $8,999 SALE PRICE MSRP: $12,574 Factory Rebate $500.00 TMS Discount $3,075.00   3/16/2018 New 2017 Yamaha YZF-R6 Motorcycles in Murrieta, CA | Stock Number: Y000710 SUBMIT First Name Last Name Zip Code Phone Number Email Address  Request More Information I'm not a robot reCAPTCHA Privacy - Terms  APPLY FOR FINANCING   TOP $$$ FOR TRADES!!!! GREAT FINANCING ON APPROVED CREDIT, PLUS FEES, SEE DETAILS!!!! 3/16/2018 New 2017 Yamaha YZF-R6 Motorcycles in Murrieta, CA | Stock Number: Y000710 The most dominant 600 cc sportbike with reigning back-to-back MotoAmerica Championships is sharper than ever with a long list of performance enhancing refinements. MSRP $12,574.00 UNIT PRICE $8,999.00 TRANSPORTATION: $0.00 ADDED MARKUP: $1,760.00 CALIFORNIA EMISSION EQUIPMENT: $100.00 Total does not include government fees & taxes, finance charges, dealer document processing charge, electronic filing charge. ANY QUESTIONS REGARDING PRICING OR UNIT SPECIFICATIONS PLEASE CALL US AT (000) 000-0000. ...
Exclusion Form. “Exclusion Form” means the document, attached hereto as Exhibit 4, and used by Class Members to request exclusion (i.e. opt-out) of the proposed Settlement Agreement.
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