Member Name. Member Email Address: I have read and agree to the terms in the Allied Federal Credit Union Mobile Deposit Service Agreement. For office use only: FSO initials FSO teller# __ Date: Member Signature: Date:
Member Name. Date: Member Signature: (or legal representative or guardian, if applicable) Jinnah Internal Medicine, LLC
Member Name. Signed:________________________________ Print: _________________________________ Title (if required): ________________________ ____________________________________ Fed. Tax ID/Social Security Number Address: ____________________________________ ____________________________________ ____________________________________ Email Address: ___________________________________ Co-Member Name (if applicable): ______________________________________ Signed: ________________________________ Print: __________________________________ Title (if required): _________________________ ____________________________________ Fed. Tax ID/Social Security Number Address: ______________________________________ ______________________________________ ______________________________________ Email Address: ______________________________________ Accepted on behalf of ADial Pharmaceuticals, L.L.C. By: Xxxxxxx X. Xxxxxxx CEO
Examples of Member Name in a sentence
Other Characteristics Tenderer's Name: Date: JV Member's Name ITT No. and title: 10.1 FORM EXP- 4.2(b) Construction Experience in Key ActivitiesTenderer's Name: Date: Tenderer's JV Member Name: Sub-contractor's Name2 (as per ITT 34): ITT No. and title: All Sub-contractors for key activities must complete the information in this form as per ITT 34 and Section III, Evaluation and Qualification Criteria, Sub-Factor 4.2.
Signature and seal of the Medical Authority, Name and seal of Member Name and seal Name and seal of the of Member Chairperson Signature/Thumb impression of the person in whose favour disability certificate is issued.
Other Characteristics 6.10 FORM EXP -4.2(b) Construction Experience in Key Activities Tenderer's Name: Date: Tenderer's JV Member Name: Sub-contractor's Name2 (as perITT34): ITT No. and title: All Sub-contractors for key activities must complete the information in this form as per ITT 34 and Section III, Evaluation and Qualification Criteria, Sub-Factor 4.2.
Other Characteristics 5.10 FORM EXP -4.2(b) Tenderer's Name: Date: Tenderer's JV Member Name: Sub-contractor's Name2 (as perITT34): ITT No. and title: All Sub-contractors for key activities must complete the information in this form as per ITT 34 and Section III, Evaluation and Qualification Criteria, Sub-Factor 4.2.
Tenderer's Name: Date: Tenderer's JV Member Name: Sub-contractor's Name3 (as perITT35): ITT No. and title: All Sub-contractors for key activities must complete the information in this form as per ITT 34 and Section III, Evaluation and Qualification Criteria, Sub-Factor 4.2. 1.
More Definitions of Member Name
Member Name. Address: City: State: Zip: Home Phone: Bus Phone: Cell Phone:
Member Name. Member Signature: Date:
Member Name. Member Signature: Date: 2022 Tierra Del Sol Golf Club Platinum Membership Continued Terms and Conditions
Member Name. Address: City: State: Zip: Home Phone: Bus Phone: Cell Phone: 2008-2009 Guest Roster Hunting Club guest roster. (By signing this roster I agree that I have read, and agree with the terms of the hunting lease)
Member Name. Division/Department: Member Signature: will be able to borrow additional cold weather items as required. Date: / / Part B - St Xxxx Ambulance Victoria, Proprietary Agreement Please read each statement below, initial your acceptance against each statement and then sign the bottom of the form. Confidentiality Agreement Initials - I agree not to disclose any confidential information regarding a patient, event organiser or other member’s personal or business affairs, or any St John’s affairs, activities, procedures or operations (“confidential information”) to any other person without their prior knowledge and the express permission of the volunteer, patient, event organiser or St Xxxx management. - I agree to only use confidential information for the primary purpose for which it has been provided to me and will not use confidential information for any personal advantage or any purpose other than which it was collected without full and open disclosure and permission for the affected individual or organisation - I agree that I will not leave the information of a patient, event organiser or member in any place where it can be seen and will ensure documentation in my charge is secured at all times in line with SJA policies. - I will not remove files, papers, plans, documents or other confidential materials from any St Xxxx location, whether written or electronic without the appropriate approval of a Line Manager. - I agree to always ensure I have the permission of another person before passing on their personal details including any contact details. - I will return all records, documents, manuals, together with any copies or extracts made or acquired by members, employees or volunteers in the course of my role at St Xxxx to my Line Manager when my membership ends with St Xxxx or if a position change dictates return of any of the above. Intellectual Property I will not use any intellectual property provided to me in the course of my involvement with St Xxxx (including all programs, manuals, documentation and artwork developed as part of my role or a colleague’s role at St Xxxx) for use by another organisation without the signed permission of the relevant General Manager or in the case of the St Xxxx national office information with express permission of the Chief Executive Officer of St Xxxx Ambulance Victoria. Conflict of Interest A conflict of interest can occur when a person’s private interests’ conflict directly or indirectly with their obligations to St Xxxx....
Member Name. (“Member”, “you” or “your) Start Date: / / Address: City _ State Zip Primary Phone: Email: ID Checked: Member # Pay Type: Amx Vis MC Dsc Name on Card: Last 4 #s on Card: MEMBERSHIP DESCRIPTION PASSPORT Membership: Monthly membership dues of $69 per month PASSPORT membership entitles Member to an allowance of $69 per month. The membership allowance can be applied to a service menu of preferred member pricing, as described below. Your membership will be honored at any location of Topper’s Salon and Health Spa, Inc. (the “Company”). Your membership and the related benefits are not transferrable to any other person or entity. You may use any accrued and unused monthly membership allowance funds for future use. However, if the membership is terminated, any accrued monthly allowance funds must be used within thirty (30) days after your final membership payment has been processed. No refunds will be issued in the event you fail to use any membership services. The monthly membership allowance can be applied to any service listed in the service menu at discounted (or non-discounted if such services are preferred) membership pricing as detailed in the active price guide at the time of receiving the service. If the Member wishes to apply their allowance balance toward a service that exceeds the balance in price, the Member is responsible for the difference in price. The Member is not limited to the allotted membership allowance per month. The membership offers the Member unlimited access to purchase other services provided by the Company at the discounted rates described in this Agreement. Members receive a 10% discount on all regularly priced retail purchases. Members receive a 20% discount for all regularly priced retail purchases made on a Wednesday. Membership allowance may be applied toward retail purchases. Prices for services may vary at each Company location. No discounts are provided to Members in connection with gift certificate/gift card purchases. PAYMENT AND CANCELLATION POLICY The initial term of this Agreement will continue for three (3) months from the Start Date (the “Initial Term”). Following the Initial Term, this Agreement will automatically renew for additional renewal terms of one month each (each, a “Renewal Term”) unless you provide the Company notice of your desire to terminate this Agreement by completing the online Passport Termination Form (available at xxx.xxxxxxxxxx.xxx/xxxxxxxxxx-xxxxxxxxxxx/) at least thirty (30) days prior to the expi...
Member Name. Address: Phone: Email: FEES: The primary member must be an adult, age 18 or older.