DCB 2020 Early Bird Ticket Sales
Event Date: Saturday, February 15th
Event Address: Adler Planetarium, 1300 S Lake Shore Dr, Chicago, IL 60605
Time: 7 pm
See you then!
Contact us at
Name of Plus One (If Applicable, please skip if you are not bringing a guest):
Early Bird - UIC Dental Student/Resident: $90
Early Bird - Midwestern Dental Student/Resident: $90
Early Bird - UIC Faculty Member: $100
Early Bird - Midwestern Faculty Member: $100
Early Bird - Practicing Dentist: $100
Early Bird - others (family/friend/sponsors): $100
Quantity (if more than 2 tickets-Example: 1 student, 2 friends)
Venmo to dentalcharitybal (ONE L!)
Chase Quickpay to
Cash to Ren Xu/Ellie Park/Jasmine Liu/Connie Woo
Check made to Dental Charity Foundation and given to Ren Xu/Ellie Park/Jasmine Liu/Connie Woo
DISCLAIMER CLAUSE - The organizers, establishments, sponsors, and volunteers of this event are not responsible for any injury, loss or damage of any kind sustained by any person while attending Dental Charity Ball, including injury, loss or damage which might be caused by the action, inaction, or negligence of others. I hereby for myself, my heirs, executors, administrators or anyone else who might claim in my behalf, covenant not to sue, and waive, release and discharge the event organizers, the Dental Charity Foundation, the establishments, sponsors, and volunteers of any and all claims of liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of my participation in this event. This Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. ASSUMPTION OF RISKS - In consideration of my participation in Dental Charity Ball, I acknowledge that I am aware of the possible risks, dangers and hazards associated with my attendance to Dental charity Ball (including the risk of severe or fatal injury to myself or others). These risks include but are not limited to the following: a) the risks associated with travel to and from location(s) to be visited during the Dental Charity Ball, including transportation provided by commercial, private and/or public motor vehicles; b) intoxication and/or alcohol poisoning from the alcohol I consume whether voluntarily or through coercion; c) the possibility of bodily injury of any kind, including dental damages, from (1) falling down, (2) entering or exiting the mode of transportation being used for the event, (3) being knocked down or being involved in a physical confrontation whether caused by myself or someone else; d) the risks associated with returning to my residence after participating in the event, whether travelling by foot or in any kind of commercial, private and/or public motor vehicle.INDEMNIFICATION AND RELEASE OF LIABILITY In return for my voluntary participation in Dental Charity Ball and related activities, I agree: 1. TO ASSUME AND ACCEPT ALL RISKS arising out of, associated with or related to my attendance to Dental Charity Ball, even though such risks may have been caused by the action(s), inaction, or negligence of others; 2. TO BE SOLELY RESPONSIBLE FOR ANY INJURY, SOCIAL AND ECONOMIC LOSS, COST OR DAMAGE which I might sustain while participating in the Dental Charity Ball even though such injury, loss or damage may have been caused by the action(s), inaction, or negligence of others; 3. TO HOLD HARMLESS AND INDEMNIFY THE EVENT ORGANIZERS, the Dental Charity Foundation, the administrators, directors, agents, officers, volunteers and employees: a) from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my participation in Dental Charity Ball and all related activities; and b) from any and all claims, demands, actions, losses and costs which might arise out of my participating in Dental Charity Ball, even though such claims, demands, actions, losses and costs may have been caused by the action(s), inaction, or negligence of others. By signing below, I consent to having the information in this document collected by event organizers. Certain personal information may be made available to federal and provincial government departments and agencies under appropriate legislative authority. Personal information is protected and will be treated as confidential. ACKNOWLEDGEMENT I acknowledge that I have read this agreement, that I have executed this agreement voluntarily and without any inducement or assurance of any nature, that I intend it be a complete and unconditional release of all liability to the greatest extent allowed by law, that I understand that I have given up substantial rights by purchasing a ticket, and that this agreement is to be binding upon myself, my heirs, executors, administrators and representatives, in the event of my death or incapacity.
Yes, I agree.
No, I do not agree.
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