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SUSAN S. KOELBLE

 

e-mail BareRoot@aol.com




AGREEMENT FOR RESEARCH

First name:
 * required
Last name:
 * required
   
Address (1):
 * required
Address (2):
City:
 * required
State:
 * required
Zip:
 * required
Phone:
Fax:
Email address:
 * required
Charges:



 
$65.00 per hour
Copies and service charges billed at cost
Travel time charges only to visit specific locations outside
City of Philadelphia
Retainer:
$200.00, credited to the number of research hours authorized
Number of hours authorized
(Minimum of 6 hrs)
 * required
Please complete the following:
Family Name(s):
Specific Goals of Research:
I understand that the researcher retains the right to use all or part of the work conducted on my behalf for instructional purposes (articles and/or lectures) and for certification puproses.
I agree

____________________                                 ____________________________
       Date                                                                Name

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Number of retained hours to be credited to the number of Research hours authorized on contract.

Number of Hours