September 18 Poverty Simulation Registration
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
At what capacity are you currently involved with benevolence to underserved people?
Your answer
Gender (optional)
Race/Ethnicity (optional)
I am interested in serving as a volunteer, who plays the role as a resource provider.
This will require an individual to arrive 30 minutes earlier to the simulation for additional training. To get the most from this simulation, it is advised that you not assume a role that is similar to experiences you have actually had.
AUDIO / VIDEO AND PHOTOGRAPHIC RELEASE FORM
By participating in the Poverty Simulation Workshop, I hereby authorize Oklahoma State University sole and exclusive rights to use, publish, copy, print, copyright or electronically transfer any or all photographs, video, or audio clips taken of me before, during, and after any activity, event or function.

I also agree that Oklahoma State University may use such photographs, video and audio recordings taken of me with or without my consent or the use of my name for any lawful purpose, including but not limited to: publicity, illustration, advertising, marketing, copyrighting, and Web content.

I hereby irrevocably authorize Oklahoma State University to edit, alter, copy, exhibit, publish, or distribute this media for activities, events, and functions, or for any other lawful purpose.

In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears.

Additionally, I waive any right to royalties or other compensation arising or related to the use of any of these photographs, video, or audio clips.

I hereby hold harmless and release and forever discharge Oklahoma State University from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I certify that am 18 years of age and am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release.

By clicking the SUBMIT button below, you agree to the above statements.

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