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Registration

Registration Fee: ($50.00)

Name

Address

Phone Number

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REGION

CITY/CHURCH

LUNCH WILL BE PROVIDED

If you have dietary restrictions:

WORKSHOP PARTICIPANTS

EMAIL OPTION: Would you liked to have your name/email shared with the other workshop participants?

PHOTO RELEASE FORM I (Releasor) consent and authorize the Christian Church (Disciples of Christ) in IL/WI to use my likeness in any photograph, video, or digital media taken at events/workshops/activities sponsored by the Chrisitan Church (Disciples of Christ) in IL/WI January 1, 2025 through December 31, 2025 in any and all of its pbulications, including print or web-based publications.

I irrevocably authorize CCIW to copy, edit, enhance, crop, or otherwise alter any Photo for use in their publications. I also waive any rights of approval or inspection of photos prior to publication.

I understand all photos are the property of CCIW and acknowledge that I am not entitled to any compensation or royalties with respect to the use of the photos.

By checking the "Yes" I am acknowledging that I have read the Photo Release form and agree to the terms of the release. The checked box represents my digital signature and authorization.

I HAVE READ AND AGREE TO T HE MEDIA/PHOTO RELEASE FORM

Coupon Code

Running Total

$0.00

Convenience Fee 3.5

$0.00

Total

$0.00

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