Registration Information

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Company

Email

Phone

Address

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State

ZIP Code

Number of Guests

Name of additional attendee(s):

Consent and Release Agreement

By checking this box, I hereby grant the United Way of Western Kentucky (UWWKY) permission to interview me and use my comments or likeness in photographs or video for any and all lawful purposes that support the creation, marketing, or distribution of any pieces of video production connected to UWWKY engagement efforts for broadcast or private use. I understand that use of my interview or likeness does not entitle me to compensation in any form, and I will make no monetary claim against UWWKY for the interviews, photographs, or videos regardless of how, when or whether such interview or likeness is used. Although my personal use is permitted, I understand that my interview or likeness in photographs or videos will become the sole property of UWWKY.

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