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04-11 April Membership Luncheon Registration Form

Date of Event: 04/11/2012


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* Required Fields

* First Name:
* Last Name:
* Company/Organization:
* Address:
 
* City:
* State:
* Zip Code:
* Email Address:

Please Read & Agree to the Following Terms

PLEASE NOTE: REGISTERING FOR THIS EVENT REQUIRES PAYMENT IN ADVANCE OR AT THE EVENT (CASH, CHECK OR CREDIT CARD).

By submitting this form you are accepting the terms of the photo and video release published below:

I hereby grant the Peoria Chamber of Commerce permission to make still or motion pictures and sound recordings, separately or in combination, and also give a production company approved by Peoria Chamber of Commerce permission to use the finished silent or sound pictures, and/or sound recordings as deemed necessary. Further, I so hereby relinquish to Peoria Chamber of Commerce all rights, title, interest in, and income from the finished sound or silent motion pictures, still pictures, and/or sound recordings, negatives, prints, reproductions, and copies of the originals, negatives, recording duplicates and prints, and further grant Peoria Chamber of Commerce the right to give, sell, transfer, and/or exhibit the same to any individual, business firm, publication, television station, radio station or network, or governmental agency, or to any of their assignees, without payment or other consideration to me. My agreement to perform under camera, lighting, and stated conditions is voluntary, and I do hereby waive all personal claims, causes of action, or damages against Peoria Chamber of Commerce, and the employees thereof, arising from a performance or appearance.
* I have read and agree to the terms stated above.
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Peoria Chamber of Commerce
Office: 623-979-3601
16165 North 83rd Avenue, Suite 101
Peoria, AZ 85382
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