Application for Use of ACEM LOGO Form (COR465)

Application for Use of ACEM LOGO

Form COR465 v2
Is this application for an individual or an organisation?*

IndividualOrganisation
Individual's Name*

TitleFirst NameLast Name
Organisation*
Address*

Street Address

Street Address Line 2

CityState

Postcode
Authorised Contact Person*

TitleFirst NameLast Name
Contact Email*
example@example.com
Contact Number*
Nature of applicant’s relationship with College – why should we approve this request*
(e.g. another medical college or other body engaged in a collaborative venture with ACEM, etc)
Are you aware of any actual, potential or perceived conflict of interest in relation to the College or College staff members?*

NoYes
Please leave details of potential conflict of interest.*
(e.g. another medical college or other body engaged in a collaborative venture with ACEM, etc)
This request relates to an ACEM collaboration/initiative and is supported by the following ACEM Executive Director*

Conjoint Applicants
Does the applicant seek approval for conjoint use of the logo (as described above) with other organisations?*

NoYes
NOTE:
- A conjoint application may be made only where all parties are involved in a single, common event or endeavour. In all other circumstances, individual applications are required.
- The applicant and all conjoint users must be signatories to this application.

Details of Proposed Usage
Date required

DayMonthYear
Intended start date of use

DayMonthYear
Intended end date of use

DayMonthYear
Details all of circumstances in which it proposed to use the ACEM logo*
Please attach a visual representation of all proposed uses of the logo, including any conjoint use with other logos.

Browse Files

Cancelof

Signature and Acknowledgements
I ACKNOWLEDGE, as the abovenamed applicant or authorised contact person for the abovenamed applicant (being an organisation):
- THAT any usage of the ACEM logo must be in accordance with the ACEM Use of the College Logo Policy and the ACEM Logo Guidelines.
- THAT any approved usage of the ACEM logo will be subject to the following general conditions of use:
  - (a) The applicant must not allow any manner of usage of the ACEM logo which might reasonably be viewed as bringing ACEM into disrepute to occur and shall to take all reasonable steps to identify and terminate any such usage.
  - (b) Any approval does not imply endorsement of any organisation, individual, service or product and is not to be so construed. The applicant must not claim or imply endorsement in any manner.
  - (c) Any approval for use of the logo may be withdrawn if any manner of usage of the logo could reasonably be construed as bringing the College into disrepute, or if there is any breach of the ACEM Use of the College Logo Policy or conditions of use.
- THAT any approved usage of the ACEM logo may also be subject to additional conditions of use specific to the individual application.
- THAT any formal offer of approval of an application will not become effective until such time as the College receives formal written acceptance of the conditions of use specified in the offer of approval from the applicant/authorised contact person for the applicant (being an organisation).
Your Signature*

Clear
Should be Empty:

Application for Use of ACEM LOGO

Conjoint Applicants

Details of Proposed Usage

Signature and Acknowledgements