Attendee Registration Form

Survive and Thrive Mental Health Event
Attendee Registration Form

T.D.D. Mental Health Event – May 23, 2026 | 1:00 PM – 5:00 PM
Basic Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Demographics
Age Range
Gender:
What Are You Most Interested In?
Select all that apply:
How Would You Like to Engage?
Photo & Media Release Waiver
Photography & Recording Notice: TDD Supportive Group, Inc. may take photographs, video recordings, or other media during the event. Your image, likeness, and/or voice may be captured and used for promotional, educational, and outreach purposes including social media, websites, newsletters, and grant reporting materials.

Release of Liability: I hereby grant TDD Supportive Group, Inc., its staff, volunteers, and representatives, the right to use any photographs or recordings in which I appear, without compensation, for the purposes described above. I waive any right to inspect or approve the finished materials.
Printed Full Name:
Signature
Should be Empty:

Survive and Thrive Mental Health Event