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Custody registration form plea... Office of Student Leadership Student Conduct / Services Office CUSTODY REGISTRATION FORM Student Information Student's Full Name: Date: Date of Birth: Grade: Phone: Names of Natural Parents (list

2014 lobbyist registration for... Date Stamp CITY OF OAKLAND PUBLIC ETHICS COMMISSION RESERVED FOR CITY CLERK USE '2014 LOBBYIST REGISTRATION FORM' (Page 1 of 2) Type or print clearly in ink. File the original with the City

Family reunion registration fo... Please send payment for infant/toddler t-shirts with this payment. MAKE CHECK OR MONEY ORDER PAYABLE TO WALKER FAMILY REUNION. Please mail completed registration form along with payment to PO Box 122 Byron Center MI 49315. All information and forms in this packet can be found online at walker-familyreunion.com. You may also fill out the online registration form and pay by credit card at Your reunion registration fee includes Friday Night s Meet Greet Reception Saturday s Family Picnic Saturday s Formal Banquet and the Family Reunion T-shirt. Walker Family Reunion Registration Packet You can stay up-to-date and get additional information at www. FREE ROOM OFFER Those who send in their initial deposit by January 23 2013 will be entered into a drawing to win a FREE reunion night stay at the family hotel Prize will be awarded at the reunion. TALENT SHOW We are looking for family members who want to put their talents on display Whether it s singing dancing stand-up comedy instrumental talents or whatever we want to see it. Please indicate on the registration form if you or your child would like to participate in the talent show. Sincerely Your Family Reunion Planning Committee In this family reunion registration packet you will find Hotel Information Registration Instructions Registration Form Complete both sides and return Please forward reunion information to family members that we may have missed. For questions please call Sandra Best 313 377-3487 or email info walker-familyreunion.com. HOTEL INFORMATION Address Holiday Inn Detroit-Livonia Conference Center 17123 Laurel Park Drive North Livonia MI 48152 Special Group Rates For Family Reunion King Beds 89. The Family Reunion Registration will include the following Family Meet and Greet Reception Family Picnic Family Banquet and Family Reunion T-shirts. In order to meet mandatory prepaid expenses that require reservations and deposits to secure facilities we are requesting that you complete your registration in full by January 23 2013 or adhere to the installment plans as listed below 2013 Family Reunion Fees Adults and kids 11 years up 60 Children ages 4-10 years old 25 Infants Toddlers Under 4 years FREE If you would like a family reunion t-shirt for your toddler you will need to pay 10/shirt. Rooms have been known to sell out fast so don t wait until the last minute Hotel Amenities For Our Family Reunion FREE Breakfast Buffet Up to 4 tickets per room FREE Wi-Fi throughout entire hotel Indoor pool hot tub pool tables Health/Fitness Center On-Site Open 24 hours FREE Shuttle to/from local attractions Within a 5 mile radius FREE Parking REGISTRATION INSTRUCTIONS Please register either online or by mail no later than January 23 2013 as we need to confirm numbers as soon as possible. walker-familyreunion*com* Celebrate our Family Reunion in Livonia MI August 2 - 4 2013 Dear family members The 2013 Walker family reunion planning committee is very pleased to announce the details of our 2013 reunion We have noticed that our family has grown in size and so this is our attempt to get everyone together share our history and create new memories.

Youth basketball registration... YOUTH BASKETBALL REGISTRATION FORM COMPLETE ONE FORM PER CHILD A PHYSICAL EXAM IS REQUIRED FOR ALL PARTICIPANTS AT LEAST EVERY TWO YEARS Check here if interested in camp Fee Please circle one Male Female T Shirt Size Youth SM Med L XL Adult SM Med L XL 2XL 3XL Participant s Name Age Address Date of birth City State Zip Parent/Legal Guardian s Name Home Phone Cell Phone Work Phone E mail Address IN CASE OF EMERGENCY Contact 1 Contact 2 Name Name Cell Work Cell Work Participant s Allergies Participant s Medical Conditions MEDICATIONS CANNOT BE GIVEN TO ANY CHILD OR ANYONE EMPLOYED BY THE SURRY COUNTY PARKS AND RECREATION DEPARTMENT. Name of Participant s Physician Physician s Telephone WAIVER OF LIABILITY RELEASE FORM I am aware of the nature of this activity and I hereby assume responsibility for to participate and to be photographed for publicity purposes. I will not hold the COUNTY OF SURRY THE DEPARTMENT OF PARKS AND RECREATION and/or its employees responsible in the case of accident or injury as a result of this participation* I understand that this completed form must be in the possession of the Surry County Department of Parks and Recreation prior to participation in this program* FOR OFFICE USE ONLY Amount Paid M. Name of Participant s Physician Physician s Telephone WAIVER OF LIABILITY RELEASE FORM I am aware of the nature of this activity and I hereby assume responsibility for to participate and to be photographed for publicity purposes. I will not hold the COUNTY OF SURRY THE DEPARTMENT OF PARKS AND RECREATION and/or its employees responsible in the case of accident or injury as a result of this participation* I understand that this completed form must be in the possession of the Surry County Department of Parks and Recreation prior to participation in this program* FOR OFFICE USE ONLY Amount Paid M.

University of mpumalanga appli... INDIVIDUAL APPLICATION FOR LICENSE TO OWN AND POSSESS FIREARMS (To be filled out by FEO Personnel only) - LICENSE CONTROL No.: - TYPE OF LICENSE: TYPE 1 OTHER LICENSE/S: Sports Shooter - TYPE 2 (To

Registration form for kidamp39... REGISTRATION FORM FOR KID S SAKE SEMINAR Please Print Payment Must Accompany Form. Proper Cash (Exact Change), Money-Orders, & Cashier s Checks are accepted & made payable For Kid s Sake Seminar.

Registration form making strid... (02064) Registration Form PLEASE PRINT NEATLY IN BLACK OR DARK BLUE INK USING CAPITAL LETTERS. PLEASE KEEP ALL WRITING INSIDE THE BOXES. * REQUIRED INFORMATION I AM A TEAM LEADER OFFICE USE ONLY $

2014 annual seminar registrati... Come to pau hana in a casual setting with your fellow professionals to relax, getyour CART and captioning questions answered, share tips and BYOB BringYour Own Briefs. Or just plain say "hello"!

Nursery registration form bibl... Child s Name: Date of birth: Address: City: State: Zip: Home # : E-mail: Parent/guardian: While your child is with us, you will be: Worship Service 9:15 hour Worship Service 11:00 hour Adult Bible

Ascent agreement and registrat... ASCENT Agreement and Registration Form th You have indicated that you are interested in enrolling in the 5 year ASCENT program. This program allows you to take a full schedule of college course work

Parenting class registration f... Fairfax County Public Schools Dunn Loring Center for Parent Services 2334 Gallows Road, Dunn Loring, Virginia 22027 Located 2 miles from Tysons Corner, easy access from either I-495 or I-66 (Nutley

Safa agent registration form This application form must be completed by the person applying for the Players Agent s Licence to be issued by the South African Football Association SAFA. South African Football Association Personal History Disclosure Application Form for a Player s Agent Licence APPLICATION FOR A PLAYERS AGENT LICENCE Full name of applicant Date of completion of form SAFA Licence All correspondence to be addressed to The Chief Executive Officer P O Box 910 JOHANNESBURG Republic of South Africa Telephone No. 011 494 3522 Facsimile No. 011 494 3013 APPLICATION INSTRUCTIONS Read these instructions and every question carefully before answering and follow any specific instruction which may be given in respect of certain questions. Return the completed form to the Chief Executive Officer of SAFA P O Box 910 JOHANNESBURG 2000 Republic of South Africa or if by hand to the SAFA House 76 Nasrec Road NASREC JOHANNESBURG Republic of The original completed application form and all the additional required information plus two copies of all pages must be submitted to the Board. The original application form must be accompanied with a photograph of the applicant taken not more than one month before the submission of this application form. If there is not enough space on the schedules for the financial information additional information of the applicant the applicant s spouse or children must be given on additional pages in the same format as those of the relevant schedules pertaining to this application form. If any details of the applicant which are reflected I this application form change before a licence has been issued SAFA must immediately be notified in writing. Answer every question in full* If you fail to answer any question or given incomplete answers or fail to submit all the additional information required your application may be rejected* NB if you comply with question 14. 2 then you need not complete questions 18 19 20 and 21. If a question does not apply to you write N/A for Not Applicable in the space provided for the answer. If there is nothing to disclose about a particular question write None in the space provided for the answer. If an alteration is made to an answer sign in full next to the alteration* All answers on this form except signatures must be typed or neatly printed in black ink. On completion each page of this form must be signed in full in the space provided at the bottom of each page. If you need additional space to answer any question please use additional pages but be sure to indicate the number s of the question s you are answering on these additional pages and clearly cross reference the additional information with the relevant questions. All dates must be in the format DAY/ MONTH/ YEAR Attach certified true copies of all pages of ID document if a new document was issued during the past twelve months APPLICANT Name First Middle Maiden if applicable Surname ID No* Current Home Address Suburb Postal Code Town / City Country home Cell Phone No* Telefax No* E-mail Address Current Business work CHANGES IN FAMILY DETAILS DURING PAST TWELVE MONTHS All applicants must disclose any changes in his/her family information in full* If a relative passed away during the past twelve months give all the information that is requested including his or her last place or residence and the date of his or her death.

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