Massage Body Registration – 2026 NC State Massage Championship

Full Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Age*

Gender*

Occupation

Emergency Contact Name

Emergency Contact Phone

Are you available Wednesday April 22nd, 2026? (from 12:30pm-5pm possibly)

YesNo

Do you have any medical conditions or physical limitations we should be aware of? (If yes, please specify)

Media Release Authorization:

I hereby grant the North Carolina State Massage Championship (NCSMC) permission to use my likeness in photographs, videos, or other digital media (“Photos”) in any and all of its publications, including print and web-based publications, without payment or other consideration.

I understand and agree that all Photos taken at or in connection with the NCSMC become the property of the NCSMC and will not be returned.

I hereby irrevocably authorize the NCSMC to edit, alter, copy, exhibit, publish, or distribute these Photos for any lawful purpose. I waive any right to inspect or approve the finished product in which my likeness appears. I also waive any right to royalties or other compensation arising from or related to the use of the Photos.

I hereby hold harmless, release, and forever discharge the NCSMC and its directors, officers, employees, volunteers, agents, and representatives from any and all claims, demands, and causes of action that I, my heirs, representatives, executors, administrators, or any persons acting on my behalf or on behalf of my estate may have by reason of this authorization.

Furthermore, the NCSMC grants permission for participants to download and share any Photos posted by the NCSMC. You may use these Photos for personal or business promotional purposes. We encourage sharing NCSMC-posted Photos!

AcknowledgmentI HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE.I

YES, I give consent to photos/video being takenNO, I do not give consent

Consent Agreement

I understand that I will be receiving massage services from competitors participating in a judged event.I understand that massage may be observed by judges and audience members.I confirm I am 18 years of age or older.I release NCSMC from liability related to participation.

Is there anything else you'd like us to know?

By signing below, I certify that all information provided is true and accurate to the best of my knowledge.