AGREEMENT AND SIGNATURE. Please sign this document and return it to Bill Plant Driving School as soon as possible, in order to confirm your agreement to the Terms. In any event, any participation or continued participation by you in the training services shall be deemed to constitute your acceptance of the Terms. Full Name (in BLOCK CAPITALS): ............................................................................................ Date: .......................................................................................................... ............... I hereby confirm my agreement to the Terms (please sign below): ........................................................................................................................................
AGREEMENT AND SIGNATURE. We hereby apply for exhibit space at the BCxA Conference. We further agree to abide by all regulations under Contract Regulations in the attached Exhibit Space Contract. This Agreement shall become effective on the date signed below and will remain in effect until all responsibilities set out arefulfilled. SIGNATURE
AGREEMENT AND SIGNATURE. I understand that WellStar reserves the right to regularly review, monitor and audit access on all systems including, but not limited to, the content of email messages, internet utilization, medical records, and other electronic records. I further understand that I do not have a right to privacy when using WellStar Network. • I understand that unauthorized access, use, discussion or disclosure of any protected health information or WellStar confidential data is a serious violation of the Federal Security and Privacy Regulations (HIPAA 45 CFR § Parts 160 and 164) and/or WellStar Privacy and Information Security policies and procedures.. . I also understand that these violations will result in disciplinary action, up to and including, immediate termination of employment. I understand that Criminal and Civil penalties may also apply, particularly in violations related to a patient’s protected health information. • I understand that my electronic signature represents my acknowledgment of this Confidentiality & Technology Acceptance Agreement and signifies I have read, understand, and am bound by WellStar’s privacy, security and confidentiality policies and procedures. Name School Sign Date Classified – Internal Use Only V.06-2014 Medical Expense Waiver Student name: (Print name) Should an injury or illness occur to a student during a scheduled visit or rotation at WellStar, the student is responsible for all expenses incurred for medical care or treatment of the injury or illness. If an injury should occur in a WellStar facility during a clinical activity, the student can be seen in the nearest emergency room. The student is responsible for any expenses incurred for treatment received at a WellStar facility. Your signature on this document indicates that you understand and agree with the above statement.
AGREEMENT AND SIGNATURE. Each of the parties, by their signatures, agree to abide by the terms and conditions of the Agreement, this day of, 20 NANNY:
AGREEMENT AND SIGNATURE. 1.1 The Parties agree to the provisions provided in this Agreement and corresponding Appendices referenced herein.
AGREEMENT AND SIGNATURE. (Each party obligated either alone or jointly and severally with others to reimburse Xxxxx Fargo with respect to the Credit must sign this Application below.) EACH APPLICANT’S SIGNATURE BELOW AFFIRMS THAT (1) IT HAS FULLY READ AND AGREED TO, (2) IT WILL BE BOUND BY, AND (3) THE CREDIT WILL BE GOVERNED BY, THE TERMS OF THIS APPLICATION AND THE TERMS OF THE STANDBY LETTER OF CREDIT AGREEMENT SIGNED BY EACH APPLICANT IN FAVOR OF XXXXX FARGO OR ANY OTHER AGREEMENT SIGNED BY EACH APPLICANT PURSUANT TO WHICH THE CREDIT IS ISSUED. THIS APPLICATION IS SIGNED BY EACH APPLICANT’S DULY AUTHORIZED REPRESENTATIVE(S) ON THE DATE SPECIFIED ABOVE. Print or Type Name of Applicant: Print or Type Name of Co-Applicant: Address: Address: Authorized Signature (and Title, if applicable): Authorized Signature (and Title, if applicable): Authorized Signature (and Title, if applicable): Authorized Signature (and Title, if applicable): Email Address (MANDATORY): Email Address (MANDATORY): DDA for Fees: Phone Number: Applicant Contact: Phone Number: For Xxxxx Fargo Bank Use Only Credit Issuance Has Been Approved in Accordance With Xxxxx Fargo’s Credit Policies and Procedures Approving Officer’s Signature Approving Officer’s Name (Print) Approving Officer’s Office (Print) AU MAC Approving Officer’s Telephone: Approving Officer’s Email: Date ¨ The Credit appears to support an obligation to make a monetary payment and should most likely be classified as a “financial obligation”. ¨ The Credit appears not to support an obligation to make a monetary payment and should most likely be classified as a “performance obligation”. ¨ The Standby Letter of Credit requested above is a syndicated transaction. I confirm that I have communicated the information regarding this transaction to the Xxxxx Fargo Syndications Group as required by Xxxxx Fargo policy. For any questions regarding this transaction, please contact ¨ Approver ¨ Applicant directly ¨ Other: AFS BOOKING: INTERFACE: YES ¨ NO ¨ Standalone: YES ¨ NO ¨ Obligor #: Commitment #: Collateral BQR CQR Purpose Code NAIC CLAS BOOKING: Standalone: YES ¨ NO ¨ Obligor #: Deal #: BDG Loan IQ Booking: Facility ID: Exception Pricing: ¨ Commission P.A. ¨ Servicing Fees
AGREEMENT AND SIGNATURE. The Lessee acknowledges they have read and will abide by the terms and conditions of this lease and understand the foregoing. LESSOR: BIG XXXX XXXXXX, INC. By: Title Lessee: Date: Lessee’s Address: Business Address: Lessee’s Home Phone: Business Phone: Emergency Phone:
AGREEMENT AND SIGNATURE. Note: Please complete the application and questions completely—your eligibility will be determined from your statements. You are encouraged to submit your completed application early. Each application will be reviewed for eligibility in the order in which it is received. By submitting this application, you are agreeing that if selected, you will positively represent the CA Milk Advisory Board during both official events such as county fairs, elementary school presentations, industry and community events as well as personal interactions. As an ambassador of the California Milk Advisory Board, the conversations you engage in, content you share or post, and comments you make on any public platform, online or off, will also reflect upon the organization; therefore, it is imperative that our Dairy Princesses embrace and internalize the values of the CA Milk Advisory Board at all times throughout the duration of their tenure. If the Dairy Princess Committee feels the above criteria are not met, they reserve the right to disburse of the scholarship as they feel deserving. I understand that if selected as District 7 Dairy Princess, I will comply with these requirements. Parental signature required for all applicants. Printed Name Dairy Princess Signature (Please type your full legal name as your signature) Printed Name Dairy Princess Parent/Guardian Signature (Please type your full legal name as your signature) Send to
AGREEMENT AND SIGNATURE. We, the undersigned, understand that the agreement is not to be considered complete until it has been reviewed and approved by an authorized University Corporation representative. Contractor is prohibited from commencing work until explicit approval has been provided by the University Corporation. Contractor Signature Date Authorized Project Signature Date
AGREEMENT AND SIGNATURE. I agree that the policy concerning confidentiality has been explained to me. I know how to access the policy and if I have questions, I can ask my supervisor.
