1. Personal Information (PLEASE PRINT)
8. Equal Opportunity Monitoring - Please select (optional)
In connection with my voluntary involvement in activities undertaken for, and with the participation and support of a non-profit organization, I hereby agree, by signing this document, for myself, my heirs, assigns, representatives, executors and administra tors to release and discharge officers and directors, employees, agents, volunteers, heirs, assigns and representatives, to the fullest extent permitted by law, from all claims, demands and actions for injuries sustained to my person and/or property as a result of my involvement in such activities, or losses or damages of any kind, whether or not resulting from negligence and I agree by signing this document to release and hold officers and directors, employees, agents, volunteers, heirs, assigns and representatives harmless from any cause or action, claim or suit arising therefrom. I hereby attest by signing this document that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release. I grant full permission for organizers to use photographs and video of me and quotations by me in legitimate accounts and promotions of these activities.