Please check one box Sample Clauses

Please check one box. Check box A. Initial Submission (for a new application); Check box B. • Revision (if you need to correct an error on a previously submitted form); Check C. 5‐year • Renewal (if your form has expired, and you need to renew it). •  2 – Your company information: • o 2A – Company Name • o 2B – Address (include both physical address & PO Box (if applicable)) • o 2C – Name of Subsidiary, Division or Department (if applicable) • o 2D – Cage Code (this is the number you’ll receive from XXX) •  3 – Data Custodian (this is the person who will be responsible for the form & is usually a security • person, export control person, etc.) • o 3A‐D all the information for this person DD2345 FRONT SECTION 1-3 • 4 – Include relevant business activity: Note: this is the most critical part of your request. • Provide a concise and detailed description of Entity's (listed in Block 2a) Business Activity. This will assist the Canadian or U.S. Government agency controlling the data in determining whether the DOD unclassified controlled technical data that you might request is reasonably related to your stated business activity.
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Please check one box. I am not a member of any Corporation or Government organization enrolled in the Zatzman Sportsplex Corporate Rate Program. I am a member of a Corporation or Government organization enrolled in the Zatzman Sportsplex Corporate Rate Program. *Corporate or Government Department Name: __________________________________ *Verification of employment (Employee Signature): ________________________________ The undersigned acknowledges that all workouts and/or activities performed at the Zatzman Sportsplex will be solely at his or her own risk and hereby releases and discharges the Sportsplex, staff and employees from any liabilities, claims, demand, injury, damage, action or cause of action, whatsoever, which may result from the use of the services or facilities of the Zatzman Sportsplex. We recommend that before beginning a new fitness or activity program persons consult with their physician. My signature above indicates my agreement to the terms and conditions above. Adult_____ Family_____ Senior_____ Youth______ Student_____Promo_____
Please check one box o The undersigned agrees that the Warrants shall be exercised by "cashless exercise" pursuant to the terms of the Warrants.
Please check one box o The undersigned agrees that the Options shall be exercised by the "net exercise" method and instructs the Company to withhold from the Option Shares that would otherwise be issued upon exercise that number of Option Shares having a fair market value equal to the aggregate Option exercise price.

Related to Please check one box

  • Check one I am a United States citizen or legal permanent resident. ▪ A valid Colorado driver's license or a Colorado identification card;

  • Request for Dues Check Off Employees shall have the right to request and be allowed dues check off for the Exclusive Representative, provided that dues check off and the proceeds thereof shall not be allowed any employee organization that has lost its right to dues check off pursuant to the PELRA Upon receipt of a properly executed authorization card of the employee involved, the District will deduct from the employee’s paycheck the dues as specified by the Union.

  • Union Check-Off The Employer agrees to the monthly check-off of all Union Dues, Assessments, Initiation Fees, and written assignments of amounts equal to Union Dues. The check-off monies deducted in accordance with the above paragraph shall be remitted to the Union by the Employer within two (2) weeks of the end of each month. The Employer shall provide the Union's Provincial Office with a list of all employees hired, and all employees who have left the employ of the Employer (who shall be designated as terminated and shall include discharges, resignations, retirements and deaths) in the previous month along with a list of all employees in the bargaining unit and their employee status and the amount of dues or equivalent monies currently being deducted for each employee.

  • PLEASE READ CAREFULLY THIS AGREEMENT INCLUDES A RELEASE OF ALL KNOWN AND UNKNOWN CLAIMS.

  • Credit Check You are authorized, in your discretion, should you for any reason deem it necessary for your protection to request and obtain a consumer credit report for the Customer.

  • Please Issue a check payable to Borrower or

  • DUES CHECK-OFF 1. The Board shall deduct from the wages of employees in the bargaining unit, upon receipt from the Union of individual authorization cards executed or individually signed by the employee, state dues and local dues or service fee for those employees hired by the Board on or after July 1, 1995. Revocation of dues shall be by written notice to the OAPSE State Treasurer, Treasurer of Local 149, and the Treasurer of the School District during the last ten calendar days of negotiated agreement. Members electing to withdraw from the Union must submit a written request, received within the ten (10) day withdrawal period, to OAPSE State Office at 0000 Xxx Xxxxx Xxxxx, Xxxxxxxx, Xxxx 00000, attention: Membership. 2. The Board agrees not to check off dues from the pay of any bargaining unit members for any other labor organization during the term of this Agreement. 3. Dues deductions shall be deducted in twenty-four equal installments starting with the second pay in September. The money collected by the Treasurer of the School District shall be forwarded to the OAPSE State Treasurer and Treasurer of Local 149 along with a list of members and the amounts individually deducted from each, no later than ten (10) working days after they are collected. A duplicate list of names and individual deductions shall be given to the local Treasurer at the time they are sent to the OAPSE State Treasurer. 4. Service Fee - Each employee covered by this Agreement who is hired on or after July 1, 1995, who fails voluntarily to acquire or maintain membership in the Union, shall be required to pay to OAPSE a service fee, which shall not exceed the dues paid by members of OAPSE who are in the bargaining unit covered by this Agreement; provided that any employee who has been declared exempt for religious convictions by the State Employment Relations Board (SERB) shall not be required to pay said fee. However, such employee shall pay, in lieu of such fee, on the same time schedule as Union dues are payable an amount of money equal to such fee to a non-religious charitable fund exempt from taxation under Section 501(c)(3) of the Internal Revenue Code, mutually agreed upon by such employee and the OAPSE state treasurer. Such employee shall furnish to the OAPSE state treasurer written receipts evidencing payment to such agreed upon non-religious fund. The provisions of this Article shall be explained to the employee at the time of the hiring interview. A written statement explaining the Service Fee shall be provided, by the Board, at the time of hire. The provisions of the service fee shall not be applicable to new hires until completion of their first sixty (60) calendar days of employment or to any employees exempt from the bargaining unit by virtue of being supervisory, managerial, confidential or casual employees. The Union shall adopt an internal rebate procedure in accordance with Section 4117.09(c) of the Ohio Revised Code which complies with Federal law. 5. The Union agrees to hold the Board harmless in any suit, claim or administrative proceeding arising out of or connected with the imposition, determination or collection of service fees for dues, to indemnify the Board for any liability imposed on it as a result of any such suit, claim or administrative proceeding to and to reimburse the Board for any and all expenses incurred by the Board in defending any such suit, claim or administrative proceeding, including attorney fees and court costs. For purposes of this section, the term “Board” includes the Board of Education of the Shaker Heights City School District, its members, the Treasurer, Superintendent, Assistant Superintendent-Business and Operations1 and all members of the administrative staff.

  • CHECK-OFF 9.01 Subject to this Article, the Employer will, as a condition of employment, deduct an amount equal to the monthly membership dues from the monthly pay of all employees in the bargaining unit. Where an employee does not have sufficient earnings in respect of any month to permit deductions made under this Article, the Employer shall not be obliged to make such deduction from subsequent salary. 9.02 The Association shall inform the Employer in writing of the authorized monthly deduction to be checked off for each employee. 9.03 For the purpose of applying clause 9.01, deductions from pay for each employee in respect of each calendar month will start with the first full calendar month of employment to the extent that earnings are available. 9.04 No employee organization, as defined in Section 3 of the Parliamentary Employment and Staff Relations Act, other than the Association, shall be permitted to have membership dues and/or other monies deducted by the Employer from the pay of employees in the bargaining unit. 9.05 The amounts deducted in accordance with clause 9.01 shall be remitted to the Association by cheque in the month following that in which their deductions were made and shall be accompanied by particulars identifying each employee and the deductions made on his/her behalf. 9.06 The Employer agrees to make deductions for other purposes on the basis of the production of appropriate documentation. 9.07 The Association agrees to indemnify and save the Employer harmless against any claim or liability arising out of the application of this Article, except for any claim of liability arising out of an error committed by the Employer limited to the amount actually involved in the error. 9.08 An employee who satisfies the Employer to the extent that he/she declares in an affidavit that he/she is a member of a religious organization, registered pursuant to the Income Tax Act, whose doctrine prevents him/her, as a matter of conscience, from making financial contributions to an employee organization and that he/she will make contributions to a charitable organization equal to dues, shall not be subject to this Article, provided that the affidavit submitted by the employee shows the registered number of the religious organization and is countersigned by an official representative of the religious organization involved. A copy of the affidavit will be provided to the Association.

  • Please Initial If you have any of the following please check: tent, trailer with hitch, if so, how many total feet long? ARE YOU BRINGNING A TENT? YES NO You can use your own tent, but you are responsible. It MUST be fire rated, clean & professional looking, and it MUST be properly secured and tied down and lowered at the end of each night. Special Provisions List specifically what products you will be selling. Will need to be approved by the festival.

  • Checkoff A. In conformity with Section 2 of the Act, 39 U.S.C. 1205, without cost to the Union, the Employer shall deduct and remit to the Union the regular and periodic Union dues from the pay of employees who are members of the Union, provided that the Employer has received a written assignment which shall be irrevo- cable for a period of not more than one year, from each employee on whose account such deductions are to be made. The Employer agrees to remit to the Union all deductions to which it is entitled fourteen (14) days after the end of the pay period for which such deductions are made. Deductions shall be in such amounts as are designated to the Employer in writing by the Union. B. The authorization of such deductions shall be in the fol- lowing form: I hereby assign to the National Association of Letter Carriers, AFL- CIO, from any salary or wages earned or to be earned by me as your employee (in my present or any future employment by you) such regular and peri- odic membership dues as the Union may certify as due and owing from me, as may be established from time to time by said Union. I authorize and direct you to deduct such amounts from my pay and to remit same to said Union at such times and in such manner as may be agreed upon between you and the Union at any time while this authori- zation is in effect, which includes a $8.00 yearly subscrip- tion to the Postal Record as part of the membership dues. Notice: Contributions or gifts to the National Association of Letter Carriers, AFL-CIO are not tax deductible as charitable contributions for Federal income tax purposes. However, they may be tax deductible under other provi- sions of the Internal Revenue Code. This assignment, authorization and direction shall be irrevocable for a period of one (1) year from the date of delivery hereof to you, and I agree and direct that this assignment, authorization and direction shall be automatically renewed, and shall be irrevocable for suc- cessive periods of one (1) year, unless written notice is given by me to you and the Union not more than twenty

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