Event Release Form
Please complete all sections below to provide your information and consent for participation and media release.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Event Name
*
Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Event Location
*
Your Role or Relationship to the Event
*
Please Select
Participant
Speaker/Presenter
Performer
Organizer/Staff
Volunteer
Guest
Other
Describe the scope of your release (e.g., photos, video, audio, written materials)
*
Signature
*
Submit Event Release
Submit Event Release
Should be Empty: