StartUp Fayette Waiver IRT Waiver Name * First Last * Last Mailing Address Mailing Address Mailing Address Mailing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * Phone * Website/URL CONSENT TO USE YOUR NAME, ETC. By participating in StartUp Fayette, you also hereby grant to Fayette Chamber the right to use your name, voice, signature, biographical information, photo, and likeness for advertising, publicity, promotional and other purposes in any and all media, now or hereafter devised, throughout the world in perpetuity, without additional compensation, notification or permission. Participation shall constitute a waiver to the extent such information may otherwise be protected under state and/or federal privacy laws (including the Family Educational Rights and Privacy Act). RELEASE. By participating in StartUp Fayette, each Participant hereby agrees to release, waive and discharge the Fayette Chamber of Commerce and its subsidiaries such as each of its officers, directors, employees, and agents, from any and all claims, demands, obligations, causes of action and liabilities which now exist or may hereafter arise that relate in any way to participation in the StartUp Fayette event or any participation in any activity, event, or excursion offered in connection with the content produced. By signing here, I acknowledge and accept the terms above. * signature keyboard Clear If you are human, leave this field blank. Submit Δ
