PUBLIC DISPLAY LICENSE REQUEST FORM

LICENSE REQUEST FORM

Public Display License
Before completing this request, please read this form in its entirety and ensure that all questions are answered completely and accurately.

NOTE: The Office of the General Counsel and Compliance (the "Office of the General Counsel") will not review incomplete submissions. If your submission is deemed incomplete, the Office of the General Counsel will notify you via the email address you provide below. Note additional requests for information may follow from your submission of this form.

We will process completed submissions within three (3) weeks, barring any additional requests for clarity or information, from receipt of a completed form.

If you have any questions concerning this process, please contact the Office of the General Counsel at legal@deltasigmatheta.org.
REQUESTOR INFORMATION
Name*

PrefixFirst NameLast Name
Title:*
Email:*
example@example.com
Address (for a business, a principal place of business is required and for an individual, a mailing address is required):*
Are you the authorized signatory?*

YesNo
COMPANY/ LICENSEE INFORMATION
Company/ Organization Name: *
Name of authorized signatory:*

PrefixFirst NameLast Name
Company Type:*

CorporationS corporationLLC501c (Nonprofit)Other
Company Address:*
Authorized Signatory Email:*
example@example.com
REQUESTED MARK(S) & INTENDED USE
Check off the mark(s) you would like permission to use:*

CrestFortitudeDelta Sigma Theta/ DSTOther
Check off the preferred color(s) and format(s) of the mark you would like to receive:*

ColorBlack & WhiteJPG (ideal for Web pages and electronic materials)EPS (ideal for printed materials)PDFOther
What is the purpose for your use of the Mark? *
Include specific details about the purpose of your use.
How do you intend to use the Mark? *
Include specific details.
If you are planning to use the Mark on a website or social media account, include the hyperlink(s) below. If none, type "N/A".*
Who do you expect to see your promotional materials or who is your intended audience? *
When do you want to begin using the mark(s)?*

MonthDayYear
Date
When do you want to end using the mark(s)?*

MonthDayYear
Date
Include design samples and mock renderings of intended use of the Mark(s):*

Browse Files

Cancelof
Provide additional details of your intended use not otherwise addressed above:*
Terms and Conditions
Signature

Clear
Should be Empty:

LICENSE REQUEST FORM

REQUESTOR INFORMATION

COMPANY/ LICENSEE INFORMATION

REQUESTED MARK(S) & INTENDED USE