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District Name Date Permanent Address Change Yes No Address 1. BY SIGNING YOU GIVE UP YOUR RIGHT TO RECOVER ANY COMPENSATION FOR ANY PERSONAL INJURIES DAMAGE TO YOUR PROPERTY OR FOR YOUR DEATH ARISING OUT OF YOUR USE OF VERTICAL 19256573595734715736157526657359573475734718657347573472573477657347686565734757355 Please fill out the Explanation of Background Screening Findings form for EACH finding reported in your background screening 2 One 1 sponsorship letter from a current employer If you are unable to obtain a sponsorship letter submit 3 character refer Note please only include accessories related to the problem you are having Please list all included accessories Accessories Included Yes 1 2 3 Please describe the problem you are having 57417574545745957460574585746157443574605744957455574545745957 Under the Family Education Rights and Privacy Act of 1974 Buckley Amendment which gives students the right to inspect and review their education records students waive their right to see speci64257c con64257dential statements and letters of recommen Important You must have an existing Google account to use Google Cloud Print Click here for information LAN connection with the machine and internet connection are required to register the machine and to print with Google Cloud Print Internet connec For security purposes please do not send credit card contributions via email DOI G GOOD JUST GOT EASIER Enroll Online wwwrotaryorggive Mail Rotary Dir ect FD420 Rotary International One Rotary Center 1560 Sherman Avenue Evanston IL 602013698 USA Fax Last name First Name Home address City State Province Postal code Country Graduation year Gender President Vice president Secretary Treasurer Editor Member Member Member Member Member Member Member Member Member Member Key number for office use only SAVE SAVE RESET RESET PRINT PRINT 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Member Name (Please Print):Social Security Number: ______-____-_____Part D – Primary Bene Please Select Please Select Please Select Please Select Please Select Please Select Please Select Please Select Last Updated March 2013The personal information you provide on the application form is c 0 1 0 Print Form Please select... Please select... Please select... Please select... Please note - for security reasons applications sent via email will not be accepted under any Post: Cambridge Engl : Cochin Gymkhana Type of Club : Family Club Postal Address : Cochin Gymkhana, Toc - H Nagar, Vyttila, Kochi – 682019, Ernakulam, Kerala Tele Numbers : +91 484 - 4021217, 2304148, Fax - 23078 B/testt-TestsTemplatex114if(parent(obj)hasanimate)print"carriedby";if(parent(obj)hascontainer)print"in";if(parent(obj)ofclassK1_room)print"in";if(parent(obj)hassupporter)print"on";}print(the)parent(ob This resource is strictly for the use of member schools for as long as they remain members of The PiXL Club. It may not be copied, sold nor transferred to a third party or used by the school after membership ceases. Until such time it may be freely used within the member school.. This resource is strictly for the use of member schools for as long as they remain members of The PiXL Club. It may not be copied, sold nor transferred to a third party or used by the school after membership ceases. Until such time it may be freely used within the member school..