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RESTRICTIONS
ON USE AND WEB LINK PROCEDURES LICENSEE APPLICATION
Deborah
Hospital Foundation ("Deborah"), subject to the policies
and procedures set forth in the "Deborah Hospital Foundation
Policy and Disclaimer on Internet Usage" (the "Internet
Policy"), encourages individuals, chapters, groups and
organizations to link to its web site as an informational
and educational resource. However, every web site that
refers or uses the name Deborah must accept the responsibility
of maintaining and promoting the goodwill and reputation
that Deborah has developed over the years. Although
Deborah encourages the interaction and exchange of information
between and among its web site and links to other sites,
no individual, chapter, group or organization (collectively,
"Licensee"), will be allowed to refer or use the name
Deborah without first obtaining Deborah's approval and
prior written permission.
If you,
or the chapter, group or organization that you represent,
wish to be a Licensee and obtain Deborah's permission
to use or refer to the name Deborah on the Licensee
web site, please provide and submit the following information: |
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1. Last
Name: ___________________________________ |
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2. First
Name: ___________________________________ |
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3. Title:
________________________________________ |
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4. Chapter,
Group or Organization Name (as applicable): |
_______________________________________________
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5. Address: |
Street:
_________________________________________ |
City:
___________________________________________ |
State:
__________________________________________ |
Zip/ Postal
Code: ________________________________ |
Country:
_______________________________________ |
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6. Phone
Number: |
work:__________________________________________
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and home
(if individual): __________________________ |
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7. Fax
Number: _________________________________ |
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8. E-mail
Address: _______________________________ |
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9. Web
site Address: _____________________________ |
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10. In
what industry are you? |
_______________________________________________ |
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11. Summary
objective of web site: (Include in your summary objective
a description of the primary purpose for using or referring
to the name Deborah) |
________________________________________________________
________________________________________________________
________________________________________________________ |
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12. Will
the Licensee web site encourage users to seek donations
on behalf of Deborah, and if so, will the Licensee web
site provide a link to Deborah's own web site for this
purpose? |
___________________________________________________ |
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electronic
filing for this form is under construction
Please print and mail the above form to: |
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Deborah
Hospital Foundation
212 Trenton Road
Browns Mills, NJ 08015 |
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BY
COMPLETING AND TRANSMITTING THIS FORM OVER THE INTERNET
TO DEBORAH, YOU AGREE TO ABIDE BY ALL OF THE TERMS AND
CONDITIONS DESCRIBED IN THE INTERNET POLICY.
PLEASE BE ADVISED THAT UNTIL YOU RECEIVE, VIA E-MAIL
OR OTHERWISE, A CONFIRMATION THAT YOUR APPLICATION HAS
BEEN ACCEPTED AND APPROVED BY DEBORAH, NO PERMISSION
OR AUTHORIZATION HAS BEEN GRANTED TO YOU, OR THE CHAPTER,
GROUP OR ORGANIZATION YOU REPRESENT, TO BE A LICENSEE
OR TO USE OR REFER TO THE NAME DEBORAH ON YOUR WEB SITE.
Should
you have any questions regarding this Application or
the terms and conditions of the Internet Policy, please
feel free to e-mail us at: dhfbo@erols.com.
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