Required Signature. I have read all of the rental policy information and by signing below, I agree to comply with the provisions of this rental agreement. I understand that my security deposit may be forfeited or I may be billed for any additional expense should any of the aforementioned requirements be ignored or abused, or if any damages are a result of the actions of my rental.
Required Signature. As the Authorized Representative of [insert name of applicant organization] Signature of Authorized Representative Date
Required Signature. I have read all of the reservation policy information and by signing below, I agree to comply with the provisions of this reservation agreement. I understand that my security deposit may be forfeited or I may be billed for any additional expense should any of the aforementioned requirements be ignored or abused, or if any damages are a result of the actions of my reservation.
Required Signature. As the Authorized Representative of [insert name of applicant organization] _________________________________________________, I hereby certify to the best of my ability that the above responses are honest and true. __________________________________________ ______________ Signature of Authorized Representative Date Appendix F – Bi-Annual Infrastructure Progress Development Measures Instructions: Please respond to all questions in the survey using information collected and funded activities completed in the past 6-month period (since the last reporting period). Please do not copy and paste responses provided in previous bi-annual survey.
Required Signature. Executive Director, Authorized Representative, or Chancellor of Postsecondary Institution:
Required Signature. I (Print full legal name) hereby known as “Client” in this agreement, agree to all matters of this LP (Limited Partnership) formed with Digital Capital Partners LLC known as “the Crypto Trading Advisor” otherwise known as GP (General Partner) on this date of , .
Required Signature. I hereby certify the statements made herein are true and complete to the best of my knowledge, and I understand that their validity is one of the conditions of coverage. Print Name Signature Date Notice of special enrollment rights If you are waiving enrollment for all healthcare coverage under the Long Beach/Orange County Plan 278 of UNITE HERE HEALTH because of other group or individual healthcare coverage existing when you first become eligible under the Plan, you may be able to enroll individuals losing that coverage in Plan 278 when eligibility for the other coverage is lost. If your waiver of enrollment is not related to other group or individual healthcare coverage, you may also request enrollment in Plan 278 when: ● You gain a dependent as the result of marriage, childbirth, adoption, placement for adoption, or a child from a foreign country takes up residence with you; ● You or a dependent lose eligibility for Medicaid or Child Health Insurance Program benefits; or ● You or a dependent gain eligibility for state financial assistance under a Medicaid or Child Health Insurance Program to help pay for the cost of UNITE HERE HEALTH Coverage. The request for special enrollment must occur within 60 days after the occurrence of the applicable event.
Required Signature. I understand and will abide by the provisions and conditions of this Agreement. I understand that any violations of the above provisions may result in disciplinary action, the revoking of my user account, and appropriate legal action. I also agree to immediately report any misuse of the information system to the site Principal. Misuse may come in many forms, but may be viewed as any messages sent or reviewed that indicate or suggest pornography, unethical or illegal solicitation, racism, sexism, inappropriate language, and other issues described above. I have read and understand each of the sections listed above and agree to follow these guidelines while using the network of the Valley Home Joint School District.
Required Signature. Blind Brook School District Network User
Required Signature. Elected Official/ Department Director: Xxxxxxx Xxxxx /s/ Date: August 25, 2022
