BERKSHIRE HATHAWAY INC

3555 Farnam Street, Suite 1440, Omaha, NE 68131, USA

DATE:
APPLICATION'S I.D:
MEMBERSHIP FORM

Name:

Address:

City:

State Zip: Date Joined:

E-mail: Phone: Date of Birth:

Amount

Ne
eded in this Project:
MEMBERSHIP LEVEL LIFETIME
MEMBER
EXECUTIVE MEMBER
GENERAL MEMBER
ASSOCIATE MEMBER
STUDENT'S MEMBER
PROJECT SPONSOR MEMBER [3
I consent to the above named member being able to take part in activities arranged by this organizations.
Additional benefits and group rates are available.

*"Letters of recommendation should come from professionals or new media industries or media-related academia; who have
at least four (4) years beyond entry level experience in the business industries and whom you have worked with orfor.

WARRANTY AS TO AGE
By personally executing this Deed, the participant warrants that he or she is at least of eighteen (18) years of age and above.
Where as this Deed is executed by a participant to this organizations in terms of rules and regulations.
CONFIDENTIALLY
The Participant must keep the terms of this Deed strictly confidential and no disclosure of the terms of this Deed is to be made
by the participant other than for the purpose of obtaining legal advice.
BINDING ON SUCCESSORS
This Deed binds the heirs, administrators, executors, personal representatives, dependants (if any) and successors of the
participant and endures for the benefit of this organizations and its successors and assigns.

PRIVACY
Our company collects information from you for the primary purpose of providing quality outdoor. We require you to provide
us with details so that we may properly attend to your needs. This means we will use the info you provide in the following
ways: administrative purposes, billing purposes (if required), disclosure for research and quality assurance activities to
improve entertainment services, and if needed, for appropriate purposes.

I promise that the information about me/participant in this form is correct. I have read and understand everything in this form
and that I am ready to proceed.

Please submit all required application materials at once for the process of your application.

Signature:

It is advisable to note that this is not a legal undertaking, the signatory will abide by the terms to reach the
objective slated in the Membership form by striving to do his/her best.