7/29/2016	ArizonaSchool BoardAssociation, poweredby CTSz2

KHC-E ©

EXHIBIT

DISTRIBUTION / POSTING OF PROMOTIONAL MATERIALS

REQUEST TO DISPLAY/POST OR STACK MATERIALS

Date ______________, 20____

______________________________________________________________ Name of organization / group

We wish to display/post or stack promotional materials on the following dates: (Not to exceed one [1] month.)

______________________________________________________________ Month	Date(s)	Year

There (will) (will not) be a charge for the instruction/activity.

The person who may be contacted, if necessary, about the content of this literature, by the school, parent, or other recipient of information is:

Name ________________________________________________________

Address ______________________________________________________

__________________________________________________________ Zip code

E-mail address _________________________________________________

Phone: (work) ____________________	(home) _____________________

I/We hereby assure the school that the organization will:

● Agree that any charges for the instruction/activities will be based on and not exceed the cost of providing the instruction/activities;

● Not use fighting words, obscenities, defamatory speech or encourage disruption of the educational environment;

●	Not provide representations or visuals that are inappropriate as described in The Children's Internet Protection Act;

● Remove the material on a date certain not more than one (1) month after it has been displayed/posted/stacked or five (5) days after the activity begins, whichever is earlier;

● Label all material with the name of the sponsoring organization;

● Provide the name, address and telephone number of the local representative for the organization prominently on the promotional material;

http://policy.azsba.org/asba/Z2Browser2.html?showset=tanqueverde#polAdvPendingAdoption	1/2

7/29/2016	ArizonaSchool BoardAssociation, poweredby CTSz2

● Have an authorized representative of the organization sign the written assurances.

The promotional material and assurance form affirming compliance shall be provided to the school office at the same time.

This request must be submitted to the school office at least two (2) weeks prior to the requested date(s).

_____________________________________________________________

_____________________________________________________________ Signatures and titles of organization representatives

FOR SCHOOL USE ONLY

Date: _________________	Principal _____________________________

Action

______ Denied or requested alteration for the following reason(s):

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

______ Approved

http://policy.azsba.org/asba/Z2Browser2.html?showset=tanqueverde#polAdvPendingAdoption	2/2