Please select one. Caterer will provide the nutrient analysis ______ Caterer will not provide the nutrient analysis
Please select one. □Credit Card: □Visa □MasterCard Or □ Debit Card: □Visa □MasterCard Card Info: Name on Card: Card Number: Security Code(cvv): Expiration Date: / / Address: City: State: Zip: Cardholder's Signature (if different from ACF customer): Customer Name: Co-Buyer Name: Signature: Signature: Date: Date: *Please include a front and back copy of the credit or debit card to be used* *$3.95 fee is only when you sign up for automatic debit 0000 Xxxxxx Xxxx #000 Xxxxxx, XX 00000 (000) 000-0000 Phone (000) 000-0000 Fax xxx.xxxxxxxxxxxxxxxx.xxx
Please select one. 🞏 I am 18 years old or above the legal age of majority in my country and intend to participate in FIRST Programs. OR
Please select one. □ I give the International Business Programs at Fresno State permission to communicate with my emergency contacts listed above regarding all issues surrounding my study abroad experience. This information may include, but is not limited to, student account information, student conduct issues, health and safety issues, emergency situations, or academics. □ I give the International Business Programs at Fresno State permission to communicate with my emergency contact in the case of an emergency only. Signature Date VISUAL/AUDIO IMAGE RELEASE FORM I grant permission to California State University, Fresno (Fresno State), its employees and agents, to take and use visual/audio images of me. Visual/audio images are any type of recording, including photographs, digital images, drawings, renderings, voices, sounds, video recordings, audio clips or accompanying written descriptions. Fresno State will not materially alter the original images. I agree that Fresno State owns the images and all rights related to them. The images may be used in any manner or media without notifying me, such as university sponsored web sites, publications, promotions, broadcasts, advertisements, posters and theater slides, as well as for non-university uses. I waive any right to inspect or approve the finished images or any printed or electronic matter that may be used with them. I release Fresno State and its employees and agents, including any firm authorized to publish and/or distribute a finished product containing the images, from any claims, damages or liability which I may ever have in connection with the taking of use of the images or printed material used with the images. I am at least 18 years of age and competent to sign this release. I have read this release before signing, I understand its contents and I freely accept the terms. Student’s Name (Please print) Signature Date
Please select one. Monthly Payment Information Check by Mail Online Credit Card (online banking or online payment) Please tell us how you heard about our service… For Office Use Tower IP Address
Please select one. ⃝ Please invoice me for the 50% deposit. (Only deposit is due at time of booking.) ⃝ Please invoice me for the full amount. Applications can be submitted by mail or email.
Please select one. No formal secondary school qualification NCEA Xxxxx 0/ Xxxxxx Xxxxxxxxxxx XXXX Xxxxx 0/ Xxxxxxx scholarship Overseas qualification (including International Baccalaureate & Cambridge exams) 14 or more credits at any level NCEA Level 2/ Sixth Form Certificate University Entrance No qualification Level 5 Diploma/Certificate Bachelor Degree or Level 7 Diploma/Certificate or Graduate Diploma/Certificate Xxxxx 0 Xxxxxxxxxxx Xxxxx 0 Xxxxxxx/Xxxxxxxxxxx Xxxxx 0 Certificate Level 6 Graduate Certificate Masters’ Degree Level 3 Certificate Postgraduate Diploma Doctorate Degree Level 4 Certificate University Entrance Not known
Please select one. 🗖In consideration for the License granted under this Agreement, AVP agrees to pay to MLS the license fees and other fees described on the attached Schedule A to this Agreement (the Fees). The Fees shall be payable as provided on Schedule A. Participant may pay the Fees on behalf of AVP, except that if Participant fails to pay any such amounts when due, AVP shall be liable to MLS for such amounts until paid. AVP agrees to pay all costs of collection of all unpaid amounts owing to MLS under this Agreement, including reasonable attorneys’ fees and costs. AVP shall be responsible for its own expenses and costs under this Agreement, and MLS shall have no obligation to reimburse AVP for any expenses or costs incurred by AVP in the exercise of AVP’s rights or the performance of AVP’s duties under this Agreement. 🗖License Fees and Payment; Participant as Guarantor of Payment by AVP; Expenses. In consideration for the License granted under this Agreement, AVP agrees to pay to MLS the license fee and other fees described on the attached Schedule A to this Agreement (the Fees). The Fees shall be payable as provided on Schedule A. If AVP fails to make any payment when due, Participant agrees to pay and shall be held liable for any such amounts. Participant agrees to pay all costs of collection of all unpaid amounts owing to MLS under this Agreement, including reasonable attorneys’ fees and costs. AVP shall be responsible for its own expenses and costs under this Agreement, and MLS shall have no obligation to reimburse AVP for any expenses or costs incurred by AVP in the exercise of AVP’s rights or the performance of AVP’s duties under this Agreement.
Please select one. In consideration for the License granted under this Agreement, AVP agrees to pay to MLS the license fees and other fees described on the attached Schedule A to this Agreement (the Fees). The Fees shall be payable as provided on Schedule A. Participant may pay the Fees on behalf of AVP, except that if Participant fails to pay any such amounts when due, AVP shall be liable to MLS for such amounts until paid. AVP agrees to pay all costs of collection of all unpaid amounts owing to MLS under this Agreement, including reasonable attorneys’ fees and costs. AVP shall be responsible for its own expenses and costs under this Agreement, and MLS shall have no obligation to reimburse AVP for any expenses or costs incurred by AVP in the exercise of AVP’s rights or the performance of AVP’s duties under this Agreement.
Please select one. The BOV Care Card program begins the third Friday in October each year and runs for ten consecutive days. We love Care Card! We will participate until we opt-out. No obligation. Opt-out at anytime by contacting us at the phone, email or fax below. We agree to participate one year only. October 17 - 26, 2014 I agree to the terms of The BOV Care Card Participation Agreement and agree to inform store personnel of the conditions outlined. The BOV Care Card Agreement accepted by: Date Authorized Signature Title THE BOARD OF VISITORS CARE CARD 0000 X. 00xx Xxxxxxx, Xxxxx 000, Xxxxxxx, XX 00000 xxx.xxxxxxxxxxx.xxx XxxxXxxx@XxxxxxxXxxxxxxx.xxx PHONE: (000) 000-0000 FAX: (000) 000-0000 CARE CARD ETIQUETTE The Care Card Etiquette is printed in each Care Card booklet. Exclusions covered by the Care Card Etiquette will not be listed with individual store descriptions. Discounts are from Friday, October 17 through Sunday, October 26, 2014 and do not apply to prior sales. Cardholder’s signature must appear on the Care Card. The Care Card is non-transferable. The Care Card may only be used by the shopper whose signature appears on the front cover. The Care Card is non-replaceable and non-refundable. Care Card must be presented at the time of the sale. SALE MERCHANDISE, GIFT CERTIFICATES AND GIFT CARDS ARE NOT DISCOUNTED. Alcoholic beverages are not discounted. Merchandise cannot be held in advance for purchase during Care Card week. Layaway payments are not honored under the Care Card discount. Special orders, catalog and internet orders are not subject to Care Card discount unless permitted by individual store. Care Card is not valid with any other offer. Discount applies only to participating stores listed in this booklet and on the website: XxxXxxxXxxx.xxx. Some additional exclusions may apply - see stores for details.
