Scholarship Terms and Conditions

Authorization:

By clicking "Submit" at the bottom of the previous page, you are agreeing to the following:

I grant my permission to Beaver Dam Women’s Health, Ltd (“BDWH”) to use, reproduce and/or publish my name, picture and scholarship essay excerpts in print or electronic promotional materials, including the Internet. Uses and disclosures authorized include: editorial content, advertising, collateral materials, website/blog content, social media content, and public relations. I verify that the information I provide is true and agree to ID verification upon winning this contest. I understand that prize money will be submitted via check straight to the academic institution of my choice upon winning this contest. I understand that once published, BDWH cannot control re-disclosure and the information is no longer protected by privacy laws. This authorization will continue for three years from the date given and may be withdrawn only by my providing a specific written rescission of this authorization. I understand that my provision of this authorization will not impact my ability to receive treatment or services from BDWH. I further certify that I am least 18 years of age, or if not, that I will submit written parental or guardian authorization as a condition for award of the scholarship. I release and discharge BDWH, it’s officers, directors and employees from any and all claims and demands that may arise out of or in connection with the use of this information, including without limitation any and all claims for libel or violation of any right of publicity or privacy. Inclusion of my name on this form constitutes an electronic signature of the above authorization. The winner must provide their social security number—applicable taxes may be incurred.

Back to scholarship page >>

 

Request Appointment

We provide comprehensive women’s health services by appointment only. Same day appointments are often available. To schedule an appointment, click the Submit link below.

Submit

Ask A Question

Have a question for the Beaver Dam Women's Health staff? Click the link below to submit your general question. For urgent medical matters, contact us at 920-885-6090 or dial 911.

Ask Now

Meet Our Team

Get to know the health specialists and doctors that make us Beaver Dam's friendliest women's health and pregnancy clinic.

Read More