Information and Waiver Form
October 4, 2018 - (Day of Action) DE says NO to Kavanaugh - Washington, DC

NOTE: All attendees are responsible for returning to the van on time for departure back to Delaware.

Name *
Cell Number *
Emergency Contact Name and Relationship *
Emergency Contact Cell/Phone Number *
Emergency Contact Address *
Pick up location and time *
Image/Media Release
Personal Conduct Agreement *
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Liability Waiver *
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