Application for License

I, [name of applicant], do hereby apply for a license to display the trademark of [association], "[trademark] " at my place of business located at [address] , in the City of , State of .

That this application is in accordance with the regulations of the [trade association].

I am cognizant of the regulations of [trade association] that govern the display of said trademark and the manner of conducting business, and I agree to abide by such regulations at all times.

Dated:_______________

______________________________
[Signature]