I am a “Black Person” as defined in the Broad-Based Black Economic Empowerment Codes of Good Practice gazetted from time to time under the Broad-Based Black Economic Empowerment Act, No. 53 of 2003, as this definition of interpreted by the courts from time to time;
I am. (i) a member of the NSO;
I am. Licensed currently to practice in five jurisdictions (DC PSY1001127; GA PSY000911; NM #1085; NY #017989; TN #3518); • Certified in Clinical Psychology by the American Board of Professional Psychology (ABClinP #5973); • A member of the National Register of Health Service Psychologists (#41589) • Certified in: o Psychoanalysis by the Institute of Contemporary Psychotherapy and Psychoanalysis (ICP+P).; o Cognitive-Behavioral Therapy for the Chronic Depressions (CBASP); o Birkman Method (Master Certification).
I am i) an employee of the User (or one of them);
I am a. ☐ not currently working for USC as an employee (faculty, staff or student worker), as an employee of a temporary agency assigned to work at USC, or as an independent contractor providing services to USC. Should this status change, I agree to notify the [department] immediately;
I am fully aware that there are inherent risks involved with scuba diving, and I still choose to voluntarily participate in said activity with full knowledge that said activity may be hazardous to me and my property. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, which may be sustained by me as a result of participating in said activity including injuries sustained as a result of the negligence of RELEASEES. I further agree to indemnify and hold harmless the RELEASEES for any loss, liability, damage or costs, including court costs and attorney’s fees that may occur as a result of my participation in said activity.
I am a current member of SEA TOW or TOW BOAT US or no towing/salvage company. In the event of an Emergency, a fuel spill or my vessel sinking, I give my full authorization to call the one checked on my behalf, or, if none is checked, then to call any service or contractor that is available on my behalf. I understand that this agreement is for the 2022 Hurricane Season only and will expire on November 30, 2022. I agree not to park any trailer around the Marina property and parking lots at all while I take out my boat. As indicated above, any charges which are billed separately after each individual storm as they occur are due withinfifteen (15) days of invoicing. This agreement will not be accepted unless it is complete and is without modification. This agreement is not transferable from one person to another or one boat to another. Slip Owners agree that they are financially responsible for compliance herewith by the occupants of their Slip. This completed form with your signature below is Due no later than April 1st, 2022. Any forms not received by April 1st, 2022 will incur a LATE FEE of $20.00. This agreement is only for the boat in Slip# . An additional form is required for every boat in every Slip. Below is my current contact information. (PRINT CLEARLY) My Best Contact Ph. # Work Ph. Alternate Ph. Valid Email Address to receive emails: Initial the one that applies; I agree to receive Text messages from the Marina on ph. # , I opt out of all text messages and understand that I am responsible for obtaining information from the Marina on my own, and that pre-Storm periods may create difficulties in making contact with the Marina. Any changes to your contact information must be forwarded to the Marina Office within 24 hrs. of that change, per the Rules and Regulations of Harbour Village Marina Inc. Signed By Slip Owner or Boat Owner (circle one) Date 2022 This Form can be faxed, mailed or presented in person only.
I am. Not student with teaching parents 2.I am ........ / Not student with state scholarship, an Romanian ethnic 3.I am ........ / Not orphaned by parents
I am. Committee /Participants for the Thesis/Dissertation Examination; Entitle ................................................................................................................. ......................................................................................................................................................................................... ........................................................................................................................................................................................ of (Mr./Mrs./Ms.)..........................................................................., A Graduate Student Master Doctoral Program Major/Pathway Faculty………………………. Affirm not take any part or all of the information in this version of thesis/dissertation to disclose or publish, prior to the release of such information to perform the patented/xxxxx patent. Committee’s /Participant’s signature……………………………………………..... (……………………………………………) Date………./ ………………./………… Student’s signature........................................................... (..........................................................) Date………./ ………………./………… Principle advisor’s signature................................................................ (..........................................................) Date………./ ………………./…………
I am. I am not affiliated with, or work for a stock exchange or a member firm of an exchange or the FINRA. Please indicate name of firm (if Applicable): (Notification of your intent to open an account will be sent to your employer in accordance with current regulation.)
