NW Indigenous Food Sovereignty Summit Registration

NW Indigenous Food Sovereignty Summit

Please fill in the form below. Space is limited and will have a wait list
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Tribe or any other ancestry you'd like to share?
Release of Liability/Assumption of Risk: By participating in the programs and activities of the NW Indigenous Food Sovereignty Summit, I agree to hold harmless the NW Indigenous Food Sovereignty Summit and release any and all rights or claims to damages that may arise in connection with or as a result of myself or my child’s participation in the programs and activities of the NW Indigenous Food Sovereignty Summit. This release applies to the NW Indigenous Food Sovereignty Summit, NAYA Family Center, NIFSA, including any and all officers, agents, employees, volunteers, sponsors, coaches, and/or damages.?
I will attend:
Permission/consent to photograph, video, interviews and quotations:
I give consent for myself or my child to participate in NW Indigenous Food Sovereignty Summit, including interviews, the use of quotes, and the taking of photographs, movies or video tapes by NW Indigenous Food Sovereignty Summit employees. I grant NW Indigenous Food Sovereignty Summit the right to edit, use, and reuse said products for non-profit marketing purposes including use in NW Indigenous Food Sovereignty Summit , NAYA Family Center grant writing and marketing in print, on the internet, and all other forms of media. I also hereby release NW Indigenous Food Sovereignty Summit, NAYA Family Center, NIFSA and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.
Permission/consent to photograph, video, interviews and quotations:
Should be Empty: