Please Choose One. ❑ Buy 1 Lesson, Get 1 Lesson FREE ❑ Buy 2 Lessons, Get 1 Lesson FREE ❑ Yes! We want to Sell the Victory Golf Pass book in our Pro Shop and will purchase # @ $35 each. ❑ We’d like to make a tax deductible contribution of $ to the Victory Hope Foundation. X Authorized Representative of Participating Club Print Name & Title Phone # Date Victory Golf Pass • 000 Xxxxx Xxxxx, Rising Sun, MD 21911 • xxx.xxxxxxxxxxxxxxx.xxx
Please Choose One. Buy 1 Lesson, Get 1 FREE | Buy 2 Lessons, Get 1 Lesson FREE G Get Noticed: Victory Group Pass participating courses will stand out with our special “G” Logo in the book - and online - for golf groups to easily locate and play. Victory Group Pass Pricing Chart VICTORY HOPE FOUNDATION ~ Donate The Victory Hope Foundation, our 501(c)(3) tax exempt private foundation benefits local and national charities. We thank you for contributing! $ Donation to Victory Hope Foundation All Donations are Tax Deductible. Example: a Dollar amount, Golf Foursome, or Gift of your choice. # of Players in Group / Per Person $ Off Discount Victory Deal Price 6-8 Players 9-16 Players 17-24 Players 25+ Players $1 - $20 $1 $1 $1 $2 $21 - $40 $2 $3 $4 $5 $41 - $60 $4 $5 $6 $8 $61 - $80 $5 $7 $9 $11 $81 - $100 $7 $9 $11 $14 $100+ $8 $11 $14 $17 X
Please Choose One. Option 1 Not applicable OR Option 2 The following field in which the Company intends to make commercial use of the Inventions generated under the Project and comprised by clause 6: field description Foreground Knowledge: All information, including any data and/or result, regardless of form and regardless of whether it is or can be protected and intellectual property rights derived thereof, which is generated under the Project by a person employed with or allocated by a Party to the Project. Invention: Foreground Knowledge that may enjoy protection as patent or utility model under the generating Party’s national law.
Please Choose One. Option 1: In accordance with the Budget, each Party shall defray own costs for its own work and no Party shall pay financial contribution to the other Party. Option 2: In accordance with the Budget, the Company shall pay to AU the following amount excl. of VAT in DKK: [amount in DKK]. VAT shall be added to any payments under the Agreement in accordance with applicable law. Unless otherwise agreed in the Budget, any payments by the Company to AU shall be made within thirty (30) calendar days from the date of AU’s invoice.
Please Choose One. Open Access Publishing - No Embargoes I authorize immediate open access to the electronic full text of my work. Open Access Publishing - 6 month Embargo I request that WMU embargo the electronic full text of my work for 6 months
Please Choose One. Click here if you are interested in GRFF providing you a 10’x10’ tent, at no additional cost. Click here if you are not interested in GRFF providing you a tent. Electrical Power: Electric can only be made available in certain areas. It cannot be provided unless specifically requested and ordered prior to the event. 3 110 (15 amp) circuits can be provided upon request, if more than 3 is required it is $15 per additional circuit.. Please list ALL electrical equipment you will be using and insert number if more than zero. Circuits requested: Additional Circuits requested: x $15 = $
Please Choose One. I (we) will make payment by: Online – Make payment online at: xxxxx://xxx.xx/2rD5LaV Check **Please do not make payment until you have received an email confirming your Vendor booth reservation.
Please Choose One. One Day Member No annual fee, fuel is 125% of current member price Non Fueling Member $30 annually Full Member $100 (includes $30 annual fee plus $70 first time charge) How paid: Check (check # ) Credit card (M/C, Visa, Amx) This application and agreement (and all terms mentioned herein) applies only to the above mentioned parties, and supersedes any previous versions. It is the responsibility of the member to read information before purchasing biodiesel fuels. Please call if you have any questions.
Please Choose One. Option 1: I prefer to pay at the time of the office visit and do not wish to leave a credit card on file. Option 2: I prefer to have my credit/debit card billed for my balance after my insurance has processed a claim. An email receipt will be emailed. Option 3: I need to make special arrangements regarding my account. I have read the KCAN billing policies and agree to pay in the manner indicated above. I understand there is a $5 service fee for paper statements and agree to pay the fee. I also understand if my card is denied at the time the xxxx becomes due immediately. I agree to pay all collection costs, including attorney fees, incurred in collection for the services provided to me. I authorized Kukurin Chiropractic, Acupuncture & Nutrition staff to contact me via email at @ . Patient Signature X Date Credit Card Revolving Payment Authorization Acct #: Security Code: Expiration Date: Billing Zip Code: Cardholder Name: This authorization is to be in effect for one year. I agree to abide by the terms of my Credit/debit card contract and authorize Xx. Xxxxxxx/KCAN to charge my account according to my instructions above.
Please Choose One. ❑ Premium invested with the Application $ (Amount of the Premium) ❑ Transfer from another registered contract (Enclose transfer form) $ (Approximate amount) ❑ Internal transfer from contract number: $ (Approximate amount) Investment Investment Guarantee Options Amount of Premium PAC Contribution Systematic Switch/ Withdrawal (sections 6 & 7) Amount $ or A 100 at Maturity B75at Maturity Amount $ or Front End Option- Sales Charge DSCOption Wire Order Number(s) Amount $ or Front End Option- Sales Charge DSCOption Fund Number Fund Name (Death Benefit Guarantee is 100 *) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ *The death benefit will be reduced to 75 at age 85. Total:
