Community POPOUT Registration Form
Name (First and Last):
*
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Date of Birth:
*
What will you be performing?
Media Disclaimer
*
By attending or participating in LoveOUTLoud programs or events, you acknowledge that you may be photographed, filmed, or recorded. These images and recordings may be used for promotional, educational, or marketing purposes by LoveOUTLoud. Do you consent to being recorded and having your image used for these purposes? Please answer Yes or No in the box above.
Do you agree with the above Media Disclaimer Terms?
*
Yes
No
How did you hear about us?
Please Select
Word of Mouth
Internet
Social Media
Describe yourself in one word.
Signature
*
Continue
Continue
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