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ESIGN Multi-day Pink Bag Event Feb 11-15 2025"

Application Agreement

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I hereby attest that the information provided in this application is true, accurate, and complete and that I am the person who is the subject of the application or have been authorized by the applicant to act on his/her behalf. By signing below, I further attest that I have read and understand the Terms & Conditions of the UBCF Individual Grant Program. By signing below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature

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INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED and you will have to reapply. If you need guidance or have questions about what to include with your application, please contact us PRIOR TO SUBMITTING YOUR APPLICATION so we can help assure you provide the correct attachments. Contact us via email at programs@ubcf.org.

I understand that I am applying to participate in the UBCF gifts-in-kind giveaway which provides those affected by breast cancer the opportunity to receive donated Product/s during an event held at a location in Huntington Station, NY

I understand and agree the processing of my application to attend United Breast Cancer Foundation’s (UBCF) Pink Bag Event® may take up to 10 (ten) business days.

I understand and agree that I will be notified via email and/or text message regarding the status of my application once it has been processed.

I understand and agree that UBCF only accepts completed applications in 1 (one) online application, and only 1 (one) application per household.

I understand and acknowledge that applications are processed and approved on a first come, first served basis, and by submitting my application I am not guaranteed to be approved.

I accept the product/s in "as is" condition. UBCF assumes no responsibility for the Product's present or future condition and I hold harmless UBCF, and its related and affiliated individuals and donors, from any injury or liability which may occur directly or indirectly as a result of my use of the Product/s. UBCF is not the manufacturer of the Product/s. I acknowledge that no representations are being made by UBCF as to the condition, use or maintenance of the Product/s. I state that I have the opportunity to inspect the Product/s and that I believe in my sole judgment that the Product/s is useful and acceptable to me. I acknowledge that the Product/s may be in new, refurbished, or used condition.

I agree that no goods, services or other benefits were exchanged in return for the Product/s. I may not sell, trade, barter or otherwise distribute the Product/s to any other person or entity. I shall utilize the Product/s solely for my personal use.

I understand that the event will take place on various dates (subject to change) in Huntington Station, NY, and that if approved I will be offered an opportunity to schedule an appointment (pick-up date and time). I will bring the approval information and photo identification with me and show it as requested or, notwithstanding having been approved, I will not be allowed to participate. At the event I will conduct myself properly and will follow the reasonable instructions of UBCF.

Gender:

Are you currently under treatment for Breast Cancer:

Are you in remission from Breast Cancer:

Would you agree to share your experience with UBCF?:

I acknowledge that I will pick up my product/s on the day of the event.

I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.

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January 2, 2025 12:26 pm EST

ESIGN Multi-day Pink Bag Event Feb 11-15 2025" Uploaded by United Breast Cancer Foundation - noreply@ubcf.org IP 76.88.32.173