PERMISSION REQUEST FOR USE OF NAHUC NAME AND

PERMISSION REQUEST FOR USE OF NAHUC NAME AND/OR LOGO

1. Region, State Association, or Chapter Name:_____________________________________

Date affiliated with NAHUC (if applicable):________________________________________

2. Contact Person:_____________________________________________________________

Contact Person Address:______________________________________________________

Contact Person Telephone Number: ( )___________________

3. Description of fund raising item (only one item per request sheet). Send item or picture of item if available.

____________________________________________________________________________

4. Slogan, words and/or logo to be used.

____________________________________________________________________________

5. Wholesale price of item:________________________________________________________

6. Quantity requesting to order:____________________________________________________

7. This item will be sold at: (check all that are applicable)

______ NAHUC Conference _________ (year)

______ Region ________ Meeting(s) Approximate date(s)___________________

______ Workshop(s) Approximate date(s)_______________________________

______ Chapter Meeting(s)

______ Other_________________________________________________________

8. Will this item be advertised for sale through the Coordinator?__________________________

9.   Submit to:     NAHUC
                            1947 Madron Rd.
                            Rockford, IL 61107
                            Fax: 1-815-633-4438