Member Signature. Date: For office use only: Date Received: Purchase Date: Account #: Location #: Approved for Rebate? ☐ Yes ☐ No No - Reason:
Member Signature. Date: _________________ Print Name: ________________________ Member Signature: ________________________ Date: _________________ Print Name: ________________________ Member Signature: ________________________ Date: _________________ Print Name: ________________________ Member Signature: ________________________ Date: _________________ Print Name: ________________________
Member Signature. Date: Print Member Name: Barcode: Cosigner Signature: Date:
Examples of Member Signature in a sentence
Faculty Member Name: IN: (First, Middle Initial, Last) Faculty Member Signature: Date: *The Employer cost of providing health benefits for Household Members is considered ordinary income and is, therefore, subject to taxes, including social security, Medicare, federal and state taxes.
Faculty/Staff Member Signature Date NAME: DATE: DEPARTMENT: Appendix D NORTHERN MICHIGAN UNIVERSITY FACULTY EVALUATION REPORT Evaluation Period (1-2 Calendar Years) This is a confidential evaluation report on a member of the Northern Michigan University faculty.
More Definitions of Member Signature
Member Signature. Date: Print Member Name: Barcode: Legal Guardian Signature: Date: Print Legal Guardian Name:
Member Signature. Member Signature: TMGC Approval: Date: 2022 Rate & Membership Information The Xxxxxxx Golf Club / Xxxxxx’x Pub 000 Xxxxxxxxxx Xxxx Xxxx Litchfield, ME 04350 207.268.3000 xxxxxxxxxxxxxxxxxx.xxx xxxxxxxxxx.xxx 2022 Season Rates G reen Fees 18 hole weekday - $40 18 hole weekend (F-Su)/holiday - $50 9 hole any day - $35 Twilight (unlimited after 3pm) - $25 Early/Late Season—$25 C art Rentals 18 holes - $22 per rider 9 holes - $15 per rider Push Cart - $10 C lub Rentals 18 holes - $20 9 holes - $15 L eague Rates Green Fee: 9 or 18—$24 Cart Fee: 9-$14 / 18-$16 Instruction Xxxxx Xxxxxxx—Director of Golf Private 30 min lesson - $50 Private 60 min lesson - $80 9 hole playing lesson—$150 Group 60 min lesson (2-5) - $200 Junior lessons and clinics available 2022 Membership Application Level Description Cost Individual Any day/time $1395 Couple Any day/time $1995 Add child to couple Any day/time $150/xx Xxxxx Adult-Under 35 Any day/time $995 Junior - Under 22 Any day/time $300 Senior Any day/time $1075 Senior Couple Any day/time $1575 Twilight Any day/after 3pm $650 Twilight Couple Any day/after 3pm $850 Cart: Single/Couple $ 725/$1195 Corporate: 4ppl / addl. Any day/time—includes cart $5150/ $950 Member Name: 2nd Adult Name: Additional Family Names: Address: Phone: Email: GHIN # Need GHIN? Y / N Membership Level/Cost: Cart Cost $ TOTAL: $ Membership Benefits Membership at The Xxxxxxx Golf Club is an affordable way to enjoy the game you love while hanging with your friends all season long. Of course you can keep the fun going after your round at Doolin’s. We’re all about Fun, Food and Friends! Other benefits of Membership: 4 complimentary green fee guest passes for regular / 2 for twilight 10% off golf shop purchases (excluding clubs) 10% off food purchases at Doolin’s Complimentary green fees for Club Tournaments and Leagues Special member tournaments 14 day advance tee time reservations Complimentary GHIN activation for the season Complimentary Membership Bag Tag (if signed up before June 1)
Member Signature. Date: Office Use Only: Reservation Date: Date Request Received: Ventana Account Number: Security Deposit Received: □ Yes □ No Reservation Approved / Denied: Office Phone: (719) 447 – 1777
Member Signature. Date: Member Signature: Date: Agency Number/Name: Agent Signature:* Date: * Agent agrees and certifies that the registered vehicle, listed above, is eligible for the membership plan. The term of this Motor Club Membership is effective from the date of sale, the Plan Effective Date, and continues for the number of months indicated in the Plan Term section above. If no term is selected, this membership will, by default, be assigned a term of one (1) month from the Plan Effective Date. Benefits are available for the covered vehicle listed above. Services are available throughout the United States, Mexico, and Canada. As a Member of this SafeRide Motor Club Program all benefits are available to the Member up to your specific benefit limits without additional payments. You are responsible for any expenses over the per occurrence limits or for any non-covered expenses. Your Membership begins on the Plan Effective Date shown on this Membership Registration page and will continue until the expiration date specified on the Membership Registration page, unless canceled in writing. You will not be required to pay any sum in addition to the membership fee and the amounts specified in this registration form for the services promised.
Member Signature. Date: STATUS: Part-Time Continuing Sub Title I Regular (contract) Federally Funded School Nurse School Psychologist Return this form to: Nashua Teachers' Union 0X Xxxxxxx Xx. Nashua, NH 03060 APPENDIX H DESIGNATED AREAS Architecture and Construction Arts, Audio-Visual Technology and Communications Blind and Vision Disabilities Childhood Development and Education Comprehensive Business Education Comprehensive Family and Consumer Science Comprehensive Marketing Education Comprehensive Technology Education Culinary Deaf and Hearing Disabilities Early Childhood - Nursery to Grade 3 Early Childhood Special Ed Nursery to Grade 3 Education Technology Integrator Elementary Education Kindergarten - Grade 6 with elementary education HQT status Engineering English /Literacy (including middle school certification) ESL; English for Speakers of Other Languages Foreign Language by certification (subject to being HQT and having taught one year in the last five years) Guidance/School Counselor Health Education Health Science Hospitality and Tourism Human Services Library Media Specialist Manufacturing Mathematics (including middle school certification) Music Education Physical Education Reading and Writing Specialist School Nurse School Psychologist School Social Worker Science by certification in specific subjects (including middle school science as a subject area) Science, Technology, Engineering and Mathematics Social Studies (including middle school certification) Special Education (including categorical areas requiring general or early childhood special education) Speech Language Pathologist or Speech Specialist Visual Art Education APPENDIX J DELTA DENTAL PREMIER NETWORK Group #127 Sublocations #4633 (Teachers) and #5182 (Retirees) Coverage A Diagnostic/Preventive Coverage B Basic Restorative Coverage C Major Restorative Coverage D Orthodontics Deductible: $0 There is no deductible on your program Covered at 100%* Covered at 85%* Covered at 70%* Covered at 50%* Diagnostic: Evaluations – two in a 12- month period Basic Restorative: Amalgam (silver) fillings Composite (white) fillings (anterior teeth only) Oral Surgery: Surgical and routine extractions Endodontics: Root canal therapy Periodontics: Periodontal maintenance (cleaning) Four cleanings are covered in a 12-month period; this can be routine and/or periodontal, in any combination. Treatment of gum disease Clinical crown lengthening – once per lifetime per site Denture Repair: Repair of a removable denture to it...
Member Signature. Date: Member Signature: Date: Title: Homeowner Xxxxxx Xxxxx Signature: Date: Title: VP, Engineering & Operational Technology INFORMATION ONLY
Member Signature. Employees Signature: Date: When selected date is a holiday, items will be processed next business day. In the event that Mid Carolina CU deposits/withdraws funds erroneously into my ACCOUNTING: account, I authorize Mid Carolina CU to reverse the transaction on my account for an amount Date Setup in ICaps: Employee: PLEASE ATTACH A COPY OF VOIDED CHECK TO THIS FORM THE ORIGNAL FORM MUST BE SUBMITTED TO ACCOUNTING DEPARTMENT WITH VOIDED CHECK not to exceed the original amount of the erroneous credit. After TWO returned items the ACH Origination item will be canceled. Mid Carolina CU reserves the right to revoke this agreement at any time providing member 15 days notice. Upon payout of this loan you must notify