Demographic Information. Agency or Check here if you are NOT working with an agency Producer Name (Registered with IRS) (Legal Entity Name) (DBA Name—Optional) TIN -- Taxpayer Type: Corp Sole Prop. LLC LLP Other Entity Phone # ( ) - Ext. Fax # ( ) - Email Mail. Addr. c/o (Optional) (Street or PO Box) (City) (State) (ZIP) Bus. Addr. (Street—must be street address, no PO boxes) (City) (State) (ZIP) Licensing/Commissions Contact Name (Optional) Phone # ( ) - Ext. Fax # ( ) - Email Do you plan to assign commissions to an agency or an individual other than yourself? (If Yes, please complete the Compensation Assignment Form for the assignment to be effective.) Yes No
Demographic Information. Except as provided below and excluding personal identifying information, NetZero agrees to provide LookSmart with the demographic and consumer data which NetZero collects during registration and compiles from its subscribers accessing the Co-branded Start Page for the sole purpose of enabling LookSmart to better target content, e-commerce and advertising opportunities to NetZero's subscribers. LookSmart agrees that such data is proprietary to NetZero and in no event shall LookSmart disclose, analyze, compile, sell or otherwise use such data for any other purpose. Furthermore, NetZero's obligation to provide such data and LookSmart's use of such data shall be subject in all respects to, and shall comply with, all current and future applicable laws, rules, regulations and orders regarding the collection, retention, use, dissemination and confidentiality of such data, and to all current and future policies and procedures of NetZero regarding the same. NetZero shall not use its policies and procedures to deny LookSmart access to the data referred to above unless such policies and procedures are reasonably designed to ensure NetZero's compliance with current and future applicable laws, rules, regulations or orders.
Demographic Information. Student’s name, year, NetID: Student’s start and end dates (not to exceed 12/6/19, the last business day of classes): Field Supervisor’s name: Field Supervisor’s title: Field Supervisor’s email address: Field Supervisor’s telephone number: Field placement/Organization mailing address: The Field Supervisor, Student Extern, and X.X. Externship Program agree as follows:
Demographic Information. We rely on our patients to keep us up to date with your family's personal information. It is your responsibility to contact our office should any of the following change: Home address (No P.O. Box information will be accepted without a valid home address.), current phone numbers for both parents, and Emergency contact information.
Demographic Information. Student’s name, year, NetID: Student’s start and end dates (Students must begin their externship by Friday, June 10, 2022, and their end date is not to exceed Monday, July 25, 2022, the last business day of classes): Field Supervisor’s name: Field Supervisor’s title: Field Supervisor’s email address: Field Supervisor’s telephone number: Field placement/Organization mailing address: The Field Supervisor, Student Extern, and X.X. Externship Program agree as follows:
Demographic Information. Information Submitted Definition/Explanation Gender Male Female – Pregnant Female – Not Pregnant Ethnicity The Ethnicity Data Protocols for the Health and Disability Sector describes procedures for the standardised collection, recording, and output of ethnicity data for the New Zealand health and disability sector. Age Group Under 19 years 19 to 29 years 30 to 39 years 40 to 49 years 50 to 59 years 60 + years Unknown
Demographic Information. Upon request, the Employer will electronically provide, demographic information of employees in the Union’s bargaining unit collected by the Employer, including but not limited to: age, gender, and race. Such information of non-bargaining unit Employees must be requested through Employer’s record request process.
Demographic Information. Grantor certifies to Bank that the information contained in the Information Schedule relative to its name, address, chief executive office, places of business, jurisdiction of organization, location of the Collateral, trade names and identity of any real property to which some or all of the Collateral is affixed is true and accurate in all respects, agrees to promptly inform Bank in writing of any changes therein or any inaccuracies thereto and acknowledges (1) that Bank is relying upon the information being complete and accurate, and (2) that Bank is under no obligation to make an independent investigation with respect to the completeness and accuracy thereof and has not made an independent investigation regarding same.
Demographic Information. Student’s name, year, XxxXX: Student’s start and end dates (not to exceed 4/26/19, the last business day of classes): Field Supervisor’s name and title: Field Supervisor’s email address and phone number: Field Placement/Organization Mailing Address: The Field Supervisor, Student Extern, and X.X. Externship Program agree as follows:
Demographic Information. 1. Review the number and percentage of the Community School’s enrolled students who are Cleveland residents and the percentages of enrolled students by race, gender, socio-economic status, participation in special education, limited English proficiency/English Language Learner (ELL) status, and homelessness;
