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Northeastern University Licensing Online Approval Form

Northeastern University Licensing Online Approval Form

Organization/Department

Are you a registered student group?
 Yes  No

Contact

Phone

E-mail

Product Type

Quantity

Purpose of Merchandise

Product will be (check all that apply):
 Sold to the general public
 Given to members only
 Sold to members only
 Other

Proceeds will be used for (check one):
 Education programs
 Support of philanthropy
 Social events (description)

 Other

Name of licensed manufacturer:

Contact

Phone

Email

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