ONLINE WATER RECYCLES DISTRIBUTION/SPONSORSHIP POLICY


Licensing Agreement for Reproduction and Distribution of Water Recycles Poster
Please indicate option requested

Fields marked in red are required and must be filled in.

OPTION 1.

OPTION 2.

 NAME 
TITLE
ORGANIZATION
ADDRESS
 Home Address   Office Address
CITY
STATE  
ZIP
HOME PHONE (include area code)
OFFICE PHONE (include area code)
FAX (include area code)
EMAIL


REPRINT INFORMATION

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I UNDERSTAND AND AGREE TO THE TERMS OF DISTRIBUTION (FULL NAME REQUIRED)

NUMBER OF COPIES TO BE PRINTED

REQUESTED DATE OF POSTER PRODUCTION