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Phone: Email. Address: City: Zip: If you are in regular attendance in a church please list it here I would like to reserve the following number of slots for the Retreat: I understand there is a $50 deposit for each slot reserved and that additional slots can be reserved for the same cost on future dates, if still available. We also understand the guidelines listed below for requesting additional slot reservations, for making final payments, and that all deposits and fees are non-refundable. Total Deposit Included: $ Contacts, please return this form AND your check for the listed deposit total to complete your reservation for the desired slots for the 2021 Men’s Retreat. Make the check payable to Arizona Southern Baptist Convention, ▇▇▇▇▇ ▇ ▇▇▇▇ ▇▇., ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇. Participants acknowledge that they attending at their own risk and that neither their church, the organizing churches, nor the camp will assume liability for their participation in this event. Attendees should choose for themselves which activities to participate in, and if a minor their accompanying adult will supervise their activity and take responsibility for their participation. The total cost per person is $150. All remaining funds are due on April 2, 2021 in order to receive an event shirt. Please make sure your men are aware of the love offerings that will be taken to show appreciation for the volunteer worship leaders and food servers. Whenever possible gather funds from your attendees and forward to us one check instead of individual checks for each attendee. Never send us cash. Please visit ▇▇▇▇▇.▇▇▇/▇▇▇ and download publicity materials. You may request additional slots at any time, if they are still available, by paying the additional deposits. It would be wise to call ahead to verify availability. Slots will be reserved on a first paid basis until the maximum capacity for this event has been reached. Unused slot deposits and payments will not be refunded. You are encouraged to transfer these slots to other attendees. Each person attending will need to sign a release of liability for Lost Canyon. This form is in addition to ours and can also be found on ▇▇▇▇▇.▇▇▇/▇▇▇ under FORMS in the side panel. The primary contact person for this event is Pastor ▇▇▇▇▇▇▇ ▇▇▇▇▇ (Pastor Chip) at First Baptist Church, Fort Mojave. He can be contacted at his cell ▇▇▇-▇▇▇-▇▇▇▇, office ▇▇▇-▇▇▇-▇▇▇▇, email ▇▇▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇, or snail mail First Baptist Church, ▇▇ ▇▇▇ ▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇. The participant...
Phone: Email. If Entity: Contact Name: The number of Shares the undersigned hereby irrevocably subscribes for is: (Number of Shares) The aggregate Purchase Price (based on a price of $5.00 per Share) for the Shares the undersigned hereby irrevocably subscribes for is: $ (Total Purchase Price)
Phone: Email address: Email address: Date of Birth: Date of Birth: Employer: Employer: Retired: Retired: If Non-U.S. Citizen, If Non-U.S. Citizen, specify Country specify Country of Citizenship: of Citizenship: C. TRUST/CORPORATION/PARTNERSHIP/OTHER Trustee’s information must be provided in Sections 3A and 3B Entity Name/ Title of Trust Date of Trust: Tax ID #: D. GOVERNMENT ID (FOREIGN CITIZENS ONLY) Identification documents must have a reference number and photo. Please attach photocopy. PLACE OF BIRTH City: State/Province: Country: IMMIGRATION STATUS U.S Driver’s INS Permanent Foreign National Employee Passport Passport License Resident Alien Identity Documents Authorization without U.S. with U.S. Card Document Visa Visa Bank Name: Account#: Bank Address: Number for the document Bank Phone#: Country of Issuance: checked above: For help completing this form, please call Investor Services at 855.320.1414 2/5 PREFERRED APARTMENT COMMUNITIES | A.1 and M.1
Phone: Email. Venue: Anticipated number of attendees: NUMBER OF DAYS/HRS FEE PER DAY TOTAL CLASSROOM 1ST FLOOR $ $ AUDITORIUM 2nd FLOOR $ $ USE OF ENTIRE BUILDING $ $ AUDIO-VIDEO EQUIPMENT & TECHNICIAN $ $ TOTAL RENT $ $ DAMAGE DEPOSIT (Must be SEPARATE CHECK) (Refundable) $ 150.00 $ PLEASE MAKE CHECK PAYABLE TO “SEQUIM MUSEUM & ARTS” ▇▇▇ ▇ ▇▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇ • This agreement is made between Sequim Museum & Arts, Dungeness Schoolhouse, and the Renter. The Museum agrees to rent the rooms identified above for the rental amount and time period indicated, based on the following conditions and terms: • Follow Current State & Clallam County COVID-19 safety recommendations • NO SMOKING and NO OPEN FLAMES allowed in the building or on the property. • Consumption or serving of ALCOHOLIC BEVERAGES are prohibited in or around the building premises. • No Pets are allowed in the building. • Use of the Elevator is for disabled persons ONLY and must be operated by a Museum Volunteer for your safety. • ▇▇▇▇▇▇ agrees to leave the premises and furniture in the same place and in the same condition as it was found at the time of rental; otherwise, all or part of the damage deposit will be used to cover expenses incurred to restore or replace the property removed or damaged. Sliding chairs & tables across wood floors will result in damage costs from your deposit. • With respect to the buildings age (Built in 1982) and National Historic site, Do not move pianos or place decorations on walls & blackboards. Use of painters’ tape on wood surfaces ONLY. NO other tape allowed. Maximum occupancy for rooms are posted for safety and structural reasons. • ▇▇▇▇▇▇ agrees to indemnify and hold harmless Sequim Museum & Arts, Dungeness Schoolhouse, its’ agents and assignees from all claims for injury to persons or property in connection with the use of the Dungeness Schoolhouse by the renter. Reservations are confirmed ONLY when full payment & agreement has been received . (Signature of Renter) (Please read and sign rental checklist on reverse side) Date _ Confirmation# Museum & Arts Center Signature _ _ Access Code: Wi-Fi: Rent Paid $ On Damage Deposit $ On Deposit Refunded $ On Sequim Museum & Arts ▇▇▇ ▇ ▇▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ | ▇▇▇-▇▇▇-▇▇▇▇ | ▇▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇.▇▇▇ | ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Sequim Museum & Arts is a non-profit 501(c) (3) All Volunteer Staff Classroom 1st FL South Room Occupancy (Maximum 30) 1- 4 hour Minimum $75 1- 8 hours (Additional $20/hr.) $100 Auditorium 2nd FL Occupa...
Phone: Email. Address: City: Zip: If you are in regular attendance in a church please list it here