Fall 2017 Liability Form - Grad. Diversity Forum
Daytime Tel# (include area code)
How will you travel to and from the event at the Channel Island campus?
NOTE: The bus sits 50 people. Once the bus is filled, you will receive an email with more information and you will be placed on a waiting list. For questions, email Erica Cullwell at email@example.com.
FULL Round-trip Bus (provided by CSUSM)
Additional registration required at Grad Forum website. DEADLINE: October 23rd, 2017:
Yes, I understand I also need to register at: www.caldiversityforum.org/register The registration code is: ekho2017 (case sensitive)
Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Yes, I have read and signed the Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Signature of Participant (or Parent, if participant is under 18 years of age)
Yes, I am at least 18 yrs of age.
By checking this box, I, as the parent of the participant, allow them to attend.
Do Not Fill This Out