By registering for the Leadership Walk, I waive all liability of Lappin Foundation and the hosts/program partners of the program I attend and all other participants for any injury suffered by me or my family. (Please note that this question needs to be answered "YES" to participate in the program)*
YesNo

First Name*

Last Name*

Cell Number*

Position*

Place of Employment*

Email*

I grant to Lappin Foundation, its representatives, and employees the right to take photographs of me in connection with the Leadership Walk. I authorize Lappin Foundation its assignees and transferees to copyright, use and publish the same in print and/or electronically. I agree that Lappin Foundation may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I waive any right to royalties or other compensation arising from or related to the use of the photographs taken of me.*
YesNo

Δ