(ATTACHED FORM 3) APPLICATION FORM LOGO AND SLOGAN USE

Logo and Slogan Use Application Form

To: Director of Biodiversity Policy Division, Ministry of the Environment, Government of Japan:

We want to use the COP10/COP-MOP5 Logo and/or Slogan, agree to observe the conditions stated herein and the COP10/COP-MOP5 Logo and/or Slogan Usage Rules, and hereby apply for approval for use as follows.

Date_____________________________

1. Name and address of party that intends to use the COP10/COP-MOP5 Logo and/or Slogan (entity name, address, and name of representative in cases when the party is not a natural person):

Signature _________________________________________________________

Full Name (block letters) ____________________________________________

Affiliation, title (block letters) _______________________________________

Name of Organization ______________________________________________

2. Purposes and locations of use:

3. Method of use (attach diagrams, etc. showing the specific method of use):

4. Desired initial use date: ________________________________________

5. Contact:

• TEL & FAX ___________________________________

• E-mail ________________________________________

• URL (in cases when the Logo and/or Slogan will appear on a website)

_________________________________________________

• Contact person __________________________________

Name: ___________________________________ Approval number: _____________________

You are hereby granted permission to use the Logo and/or Slogan as specified in the above Application Form. However, the Ministry of the Environment shall bear no responsibility whatsoever for any loss, damage, claim or liability which may arise from the use of the Logo and/or Slogan. By using the Logo and/or Slogan you agree to fully indemnify the Ministry against any claims arising out of your use of the Logo and/or Slogan.

The nonexclusive license granted hereunder may be revoked at any time without prior notice at the sole discretion of the Ministry. Any dispute arising hereunder shall be determined exclusively in the Courts of Japan. This license is to be interpreted under the laws of Japan.

Also, in cases when there are any changes to the contents of the above Application Form you must promptly submit a Logo and Slogan Use Change Application Form.

Date_____________________________

Director of Biodiversity Policy Division, Ministry of the Environment, Government of Japan:

Signature _____________________________________________________