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Form preview Online event registration form Girl Scouts--Dakota Horizons 1002 43rd St S, Fargo, ND 58103 701-293-7915 or 877-904-8168 Fax 701-293-7962 Attn: Event Registrar Event Registration Form Opening date (Oct-Jan events) is August 27,
Form preview Lic3 2013 2019 form Experience must be within the previous ten years and the LIC4 form required Continued on the following page Application must be typed 03/13 LIC3 PAGE 2 6 Licensing History List all licenses certifications or registrations issued to you by City or State. LIC3 Registration Form Application Type Applicant Information Required for all applications. Original Renewal First Name Change / Re-issue Middle Initial Registration Number Last Name Social Security No. Date of Birth m/d/y Home Address Home Telephone City State Zip Mobile Telephone E-Mail Business Name Business Address Business Telephone Registration Type Construction Superintendent complete section 5A Concrete Safety Manager complete section 5B Qualifying Experience For New Applicants Only 5A For Construction Superintendent only New York State Licensed Registered Architect New York State Professional Engineer Provide license number here Experience as a Construction Superintendent Minimum five years of experience within the previous ten years LIC4 form required 5B For Concrete Safety Manager only Registered Design Professional with at least five 5 years of experience within the past ten 10 years in concrete operations at least one 1 of which was in concrete operations where the concrete portion of the project s involved the placement of a minimum of two thousand 2 000 cubic yards of concrete. Experience must be within the previous ten years and the LIC4 form required Certified Site Safety Manager with at least five 5 years of experience within the past ten 10 years in concrete operations at least two 2 of which were in concrete operations where the concrete portion of the project s involved the placement of a minimum of two thousand Five 5 years of experience within the past ten 10 years in concrete operations at least three 3 of which were in concrete operations where the concrete portion of the project s involved the placement of a minimum of two thousand 2 000 cubic yards of concrete. Experience must be within the previous ten years and the LIC4 form required A bachelor s degree in engineering or an appropriate engineering technology degree with at least five 5 years of experience within the past ten 10 years in concrete operations at least two 2 of which were in concrete operations where the concrete portion of the project s involved the placement of a minimum of two thousand 2 000 cubic yards of concrete. Include Driver License NAME TYPE LIC. /CERT. /REG* NUMBER STATUS active / not active EXPIRATION DATE Select One Yes No Have any licenses/ certifications/ registrations issued to you ever been suspended restricted or revoked or have you ever been censured or disciplined in connection therewith If Yes please indicate in Section 7 the type of license / certification / registration along with the reason for suspension restriction or revocation* No Has any person named on this application ever been employed by DOB or any other NYC agency If Yes to any of the above please provide the details in Section 7.
Form preview Reg fax registration form rev... FAX REGISTRATION FORM Current Dowling Juniors, Seniors and Graduate students who have Student Financial Services' clearance may register by FAX to 631-244-1055. NOTE: Individuals are not permitted
Form preview Eckerd college event registrat... Eckerd College Event Registration Form Complete and return this form to the Office of Campus Activities in Brown Hall within 5 business days of event. Event and event location is not confirmed until
Form preview Class enrollment form template Cohort # & Location ESL Endorsement REGISTRATION FORM First Name MI Last Name ESL XX Location Social Security # XXX-XXStudent ID# Address Apt. City State Zip Area Code Home Phone Class # Course
Form preview Golf registration form templat... CalU University Technology Services Scholarship Fundraiser 4 Person Scramble Golf Outing Monday, September 12, 2011 Cedarbrook Golf Course 724-929-8300 Shotgun Start 9:00 AM - Rain or Shine 215 Route
Form preview Upholstered and stuffed articl... STUFFING AND UPHOLSTERED AND STUFFED ARTICLES ACT ARTISAN S PERMIT ARTISAN Name Address Civic number and street Province/State City Country Postal code/Zip Types Fees Telephone Email Contact Fax Artisan permit C Artisan / Renovator - permit BC I manufacture fewer than 100 stuffed articles a year permit C1 19 CAD articles a year and I repair permit I manufacture 100 to 499 stuffed 44 CAD BC2 124 CAD 94 CAD BC3 174 CAD BC1 99 CAD FEES ARE EFFECTIVE FROM JANUARY 1 TO DECEMBER 31 2012 TYPE OF UPHOLSTERED OR STUFFED ARTICLES Furniture Bedding Sporting goods Toys Cushions Other specify Clothing TYPE OF STUFFING USED IN THE UPHOLSTERED OR STUFFED ARTICLES I CERTIFY THAT THE INFORMATION GIVEN IN SUPPORT OF THIS APPLICATION IS ACCURATE Date Signature Name of signatory THIS APPLICATION MUST BE ACCOMPANIED WITH A CHEQUE OR POSTAL MONEY ORDER PAYABLE TO THE MINISTER OF FINANCE OF QU BEC AND ADDRESSED TO DIRECTION DU COMMERCE ET DE LA CONSTRUCTION MINIST RE DU D VELOPPEMENT CONOMIQUE DE L INNOVATION ET DE L EXPORTATION e 380 rue Saint-Antoine Ouest 4 tage Montr al Qu bec CANADA H2Y 3X7 T l phone 514 499-2176 Fax 514 864-9276 rembourrage mdeie. gouv.qc.ca Web site www. mdeie. gouv.qc.ca/commerceen Direction du commerce et de la construction Minist re du D veloppement conomique de l Innovation et de l Exportation Montr al Qu bec H2Y 3X7 CANADA. gouv*qc*ca Web site www. mdeie. gouv*qc*ca/commerceen Direction du commerce et de la construction Minist re du D veloppement conomique de l Innovation et de l Exportation Montr al Qu bec H2Y 3X7 CANADA.
Form preview Soccer registration form KENDALL SOCCER COALITION 2009-2010 SEASON TRYOUT REGISTRATION FORM Tryout Player s Last Name Player s First Name Gender Birth Date Boy Girl Home Telephone Player s Cell Phone Club/Team Played for Last Season Player s Email Preferred Age Group Preferred Position Father s Name Father s Cell Phone Father s Email Home Address City Zip Code HS Grad Year In recognition of and with knowledge of the fact that engaging in the sport of soccer could involve substantial risk of personal injury I the undersigned warrant that my child is in good physical condition and hereby agree to assume the risk of any injury he or she may suffer as a result of his/her participation in try-outs at Kendall Soccer Coalition. Therefore in consideration for being permitted to participate in such try-outs I hereby release waive and forever discharge Kendall Soccer Coalition its Coaches and trainers from any and every claim demand or actions of whatever kind arising from any bodily harm or personal injury resulting from any accident which may occur as a result of participation in these try-outs. Further and to the same extent and scope I release said parties from any claim whatsoever which may be attributable to the receipt of first aid or other emergency treatment rendered my child in connection with his or her participation in such try-outs. I understand that Kendall Soccer Coalition will not provide any assistance with any medical bill s associated with the try-out should my child be injured* Parent/Guardian Signature Date. Further and to the same extent and scope I release said parties from any claim whatsoever which may be attributable to the receipt of first aid or other emergency treatment rendered my child in connection with his or her participation in such try-outs. I understand that Kendall Soccer Coalition will not provide any assistance with any medical bill s associated with the try-out should my child be injured* Parent/Guardian Signature Date.
Form preview Vfbb c mb b form IFAA recognised styles (2010) STYLE ADULT (17 plus) FEMALE BAREBOW-RECURVE BAREBOWCOMPOUND FREESTYLE LIMITEDRECURVE FREESTYLE LIMITEDCOMPOUND MALE CUB (Under 13) FEMALE MALE JUNIOR (13 - 16) FEMALE
Form preview Player registration form California Youth Soccer Association South 20 - 20 SEASON PLAYER REGISTRATION APPLICATION PLEASE PRINT A required field Parent/Admin Information First Name At least one is a required field. Program Admin Application MI Last Name Relation Street Address City State Zip Home Phone Work Phone Cell Phone Email Gender M - Male F - Female Player Information Preferences q New Player q Returning Player If returning player Cal South Player ID M F DOB MM/DD/YYYY Rank Seasons Played Height School Name ft. Grade League Club Shirt Size Team ID Number Sock Size Age Group Division in* lbs. Player Level Recreation Competitive Emergency Contact 1 Phone List any medical problem s /physical limitation s player has Parental/Volunteer Support q Coach q Manager q Referee q Board Position q Fields q Publicity q Concession q Fundraising YOU RE A CAL SOUTH MEMBER GET YOUR BENEFITS LEAGUE USE Date Received Your League is affiliated with Cal South California Youth Soccer Association South the premiere state youth soccer association in the United States. This means your family is also Birth Certificate Checked a Member of Cal South and receives all of the benefits that come with it. To learn more go to Payment Received Cash Check www. CalSouth. com and click on Member Benefits under Member Central* IMPORTANT I/We the parent/guardian of the above named player a minor and the above named player agree to the following 1 To abide by the rules of Cal South its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for Cal South accepting the registrant for its soccer programs and activities the Programs I hereby release discharge and/or otherwise indemnify Cal South its affiliated organizations and sponsors their employees and associated personnel including the owners of fields and facilities utilized for the Programs against any claim by or on behalf of the registrant as a result of the registrant s participation in the Programs and/or being transported to or from the same which transportation I hereby authorize. 2 To authorize my child s school to verify the date of birth of my child from school records to a Cal South authorized representative for the limited purpose of Cal South player age verification* 3 To hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life limb or well-being of my dependent. 4 To hereby give my consent to Cal South to take photographs video recordings and/or sound recordings of the above named player in documenting the activities of Cal South s programs. I grant Cal South permission to use the negatives prints motion pictures video/audio tapings or any other reproduction of the same for Cal South educational and promotional purposes in manuals on flyers on the world wide web or in other publications. As a parent or legal guardian of the above named player I request that the registrant s name be removed from the Association s product mailing list.
Form preview Low zone registration form Transport for London Low Emission Zone Vehicle Registration Use this form if your vehicle is affected by the Low Emission Zone LEZ and Transport for London TfL does not have all the relevant details of your vehicle on their database. Checklist Before sending this form to us please check that you have completed the following Have checked compliance status of vehicle at tfl.gov.uk/lezlondon Section 1 - About you Photocopied vehicle registration document supplied Section 5 - Declaration signed and dated If any of the below has been completed in Section 3 please provide the relevant proofs Eligibility for a 100 discount for a Showman s vehicle Photocopied proof that a pollution abatement device has been fitted Please only send photocopies of documents - originals will not be returned. 5. Declaration read and understood it. If you do not sign and date this declaration then your application will be rejected. By signing this form I certify that I fully understand the criteria for registering a vehicle affected by the London Low Emission Zone LEZ with Transport for London TfL as set out in the guidance notes. TfL holds records for most GB registered vehicles. You should check your vehicle information held by TfL for the LEZ by using our Compliance Checker at tfl*gov*uk/lezlondon or by calling 0845 607 0009 from the UK 44 20 7310 8998 from abroad and by textphone if you have impaired hearing on 020 7310 8999. A photocopy of the vehicle registration document must be supplied with the completed form otherwise your application will be rejected* Please read the guidance notes before completing this form* Information that must be provided 1. About you Account number if known Title Mr Mrs Ms First name Middle name Last name Company name if applicable Building name or number Street District Town/City County Postcode/ZIP Your contact phone number MAYOR OF LONDON LEZREGFORM Miss Other Organisation Email address How would you like us to contact you By email By post 2. About the vehicle Please tick one of the following to indicate the type of vehicle being registered and fill in the relevant information* Heavier Lorries Goods vehicles exceeding 12 tonnes gross vehicle weight Gross weight tonnes Lighter Lorries Buses and Coaches Passenger Vehicles with more than 8 seats plus the drivers seat exceeding Number of seats incl* driver Large Vans tonnes unladen and 3. 5 tonnes gross vehicle weight Unladen weight Minibuses Cars motorcycles and small vans under 1. 205 tonnes unladen weight are not included in the LEZ. N*B. The vehicle weight is a good guide as to when your vehicle will be affected by the LEZ. If your type of vehicle does not appear here you should use the weight limits used for lorries and large vans set out in the guidance notes as a guide and/or contact your vehicle manufacturer or Transport for London TfL for guidance. Please complete the following details which can be found on the vehicle registration document V5C Country Issuing the Registration Certificate Vehicle Registration Mark Number Plate Date of first registration DD/MM/YYYY Vehicle Identification Number VIN /Chassis Number/Frame Number Make Model YYYY Year of Manufacture Fuel type.
Form preview Dance team application form 2011-12 UT Spartans Dance Team Application Name: Birth Date: Cell phone: Student ID: Campus Box #: Student Status: Major: Primary Email: Local Address or Dorm: City: Zip: Shoe Size: Shirt Size: Short

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