Oral Aesthetic Advocacy Group Inc (OAAG)
Grant Applicant / Recipient Agreement
Date of Board Approval: June 1st, 2010
As an applicant, or potential recipient of a grant from the OAAG, I agree to the following terms:
1. I certify that any funds which may be disbursed to me by the OAAG will be used only for the purpose of a cosmetic dental treatment plan.
2. Should I not undertake the procedure within 3 months of receipt of the Grant proceeds, I will forego my award.
3. I understand that any proceeds I may receive from the Cosmetic Dentistry Grant Program can only be applied toward Cosmetic Procedures and that I am responsible for any basic dentistry costs such as fillings, root canals, extractions and teeth cleaning.
4. I am responsible for informing the OAAG of any change or changes in my name or address during the period of time comprised of applying for a Cosmetic Dentistry Grant, and receipt of any Grant proceeds that may be awarded.
5. I agree that OAAG may provide my information to authorized dental practitioners, their respective staff, third-party agents, volunteers or subsidiaries, for the purpose of booking my assessment and consultation, and to communicate with me regarding the status of my grant application; and/or to perform functions such as customer service, etc.
6. I agree to allow the OAAG to publicize the disbursement of funds to me without prior notification to me. (We will not identify the nature of your treatment.)
7. I agree that the OAAG may use my name, as well as other independently gathered information about me that is already in the public domain.
8. I am aware that this includes, but is not restricted to, publication in the OAAG Newsletter, Corporate Sponsorship campaign advertisements, letters and brochures.
9. If I am awarded a Grant, I will write a thank-you letter to the Organization that acknowledges the award. The Grant proceeds will not be awarded unless/until a thank-you letter is received.
10. I certify that I am at least 18 years of age.
Submitting an application for a Cosmetic Dentistry Grant confirms you have read, understand and agree to the terms of these guidelines and agree to comply with them.