Waiver Form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *AddressCity, State ZipParagraph TextIn consideration of the opportunity to appear on an audio/video tape depicting various aspects of the presentations and activities of the 2021 USA/Canada Lions Leadership Forum, the undersigned hereby waives any and all rights and interests in said audio/video tapes, relinquishing said rights to the 2021 USA/Canada Lions Leadership Forum, including, but not limited to, the right to receive any and all proceeds derived from the sale of said tapes for educational and promotional purposes. Option 1: SignatureBy typing Name you are signing this documentOption 2: ELECTRONIC SIGNATURE:Clear SignatureIMPORTANT NOTICE: Typing your name in the box above will constitute your electronic signature.Date / TimeDateTimeSubmit
