PLEASE COMPLETE THE FOLLOWING INFORMATION. Full name and address of the holder of the Shares (hereinafter: the “Shareholder”) Name(s): _________________________________________________________________________________________________ Street/House: ______________________________________________________________________________________________ Town/City: ________________________________________________________________________________________________ Postcode: _________________________________________________________________________________________________ County/State: ______________________________________________________________________________________________ Country: _________________________________________________________________________________________________ Please state the number of Shares that you wish to tender: _________________________________________________________ Please state the registered number(s) of the Shares that you wish to tender: ______________________________________________ Please insert your bank account details for the payment of the Offer Price per Share: Bank Account Number: _______________________________________________________________________________________ SWIFT address: _____________________________________________________________________________________________ Please sign for acceptance ____________________________________________________________________________________ At: _______________on____/_____/2010 This form will serve as a deed of transfer (akte xxx xxxxxxxx) with respect to Shares that are evidenced by a registration in the Company’s Dutch shareholders’ register referenced herein. Please also consult the Offer to Purchase for a full explanation of the Offer.
PLEASE COMPLETE THE FOLLOWING INFORMATION. XXXXXX, XX 00000
PLEASE COMPLETE THE FOLLOWING INFORMATION. The Main Guest Name: Address (for DD Refund): Email: Tel/Cell: You must disclose the exact number and names of the Guests (including all children) who will be occupying the Property between the above dates. This is subject to the maximum number set out below. You must immediately notify us, by phone or in writing, if the number of guests changes. Please fill in the attached GUEST LIST. If you arrive with additional people not on the Guest list, they will not be permitted to enter Xxxxxx Xxxxxxx.The Main Guest agrees to leave the property in the same condition as found. Any missing items or damage will be charged. (See attached DAMAGES & LOSSES) Daily Cleaning and Cooking services for up to 3 meals a day are included. Air-conditioning used beyond 12 hours out of every 24 hours per room will be billed separately. Other service requests will be billed separately. The Main Guest confirms (s)he has read and agreed to the “Marina Chacala Code of Conduct Rules.” Owner and Marina Chacala condominium assumes no liability for property loss or damage, nor liability for accidents, injury or death on the property or within the Marina Chacala compound. The Main Guest is responsible for the Property and all the other Guests during occupancy of the Property. Maximun # of Guests: 12 (including children) Arrival: . Departure: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
PLEASE COMPLETE THE FOLLOWING INFORMATION. EvEnt DatE(S) LaSt namE: lllllllllllllll EvEnt namE XxXX(S)/aCtivity(iES) EntERED aDDRESS: llllllllllllllllll FiRSt namE: lllllllllllllll m.i.l StatE: ll Zip CODE: lllll City: llllllllllllllllllll phOnE numbER: lll lll llll l DatE OF biRth ll ll llll WOlRlS ClatlEglORly (lJunlior,lCitlizenl, Clitizeln Cllydlesdlale,letcl.) ll conditions. I fully understand that participating in the Event is an extreme test of a person’s physical and mental limits and may involve the risk of serious injury or death, economic loss, property damage or loss that may result from my own actions, inactions or negligence, and also from the actions, inactions or negligence of others. I understand and voluntarily assume these risks.
PLEASE COMPLETE THE FOLLOWING INFORMATION. EvEnt DatE(S) lllllllllllllll EvEnt namE XxXX(S)/aCtivity(iES) EntERED LaSt namE: extreme test of a person’s physical and mental limits and may involve the risk of serious injury or death, economic loss, property damage or loss that may result from my own actions, inactions or negligence, and also from the actions, inactions or negligence of others. I understand and voluntarily assume these risks.
PLEASE COMPLETE THE FOLLOWING INFORMATION. If you prefer to complete this form electronically, it is available for downloading at xxx.xxxxxxxxxxx.xxx.
PLEASE COMPLETE THE FOLLOWING INFORMATION. It is my understanding that will be participating in a fitness evaluation and exercise program. This patient is permitted to participate in the following activities. (Please check all that apply.)
PLEASE COMPLETE THE FOLLOWING INFORMATION. EMPLOYEE NAME SCHOOL/DEPARTMENT I have read and agree to abide by the Staff Network and Internet Use and Safety Policy and Guidelines. I understand that any violation of the terms and conditions set forth in the Policy is inappropriate and may constitute a criminal offense. As a user of the Board’s computers/network and the Internet, I agree to communicate over the Internet and networks in an appropriate manner honoring all relevant laws, restrictions and guidelines. EMPLOYEE SIGNATURE DATE
PLEASE COMPLETE THE FOLLOWING INFORMATION. YOUR NAME _________________________TODAY’S DATE ___________________________________ ADDRESS___________________________ CITY _____________________ ST _______ZIP__________ PHONE______________________________E-MAIL ___________________________________________ EMERGENCY CONTACT________________EMERGENCY CONTACT PHONE_____________________ I ATTEST THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER (OR THAT IF I AM YOUNGER, MY PARENTS OR LEGAL GUARDIAN HAVE EXECUTED THIS WAIVER BELOW), AND THAT I AM PHYSICALLY FIT AND SUFFICIENTLY TRAINED TO PARTICIPATE IN ALL ACTIVITIES ASSOCIATED WITH THE EVENTS AND MY PARTICIPATION IN SUCH EVENTS IS VOLUNTARY. _______________________________________ ________ _____________ Signature of Participant DOB DA
PLEASE COMPLETE THE FOLLOWING INFORMATION. Name of Financial Institution Branch Address City State Zip Routing & Transit Number (attach VOIDED check) Name of Party on Account Account Number Start Date Frequency of Dues Paid: M Q A I would like WindRiver Club to debit my credit card or ACH for: Dues Club Charges On File This authorization is to remain in full force and effect until WindRiver Club LLC has received written notification from me (or either of us) of its termination in such time and in such manner as to allow both Financial Institutions a reasonable opportunity to act on it. I (we) agree to:
