Fall 2021 Seminar Registration Form
Welcome! We are so excited to have you join us virtually this Fall! While our seminar days will look slightly different than the past we are excited to bring to you all a Miniseries of amazing speakers! Please complete our registration form to secure your spot in our 2021 Fall Seminar. It is our expectation that you attend all three days of the seminar. Your information will not be shared with any other parties and is for the sole use of CLLS.

Seminar Dates:
October 19 - October 21 | 9:00AM-12:00PM | Virtual via Zoom
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Email *
Name (Last, First) *
Phone Number *
Mailing Address *
Branch of Service *
Military Status *
Sponsor Rank *
Sponsor Unit Affiliation *
Who is the Military Point of Contact within your Unit (name, phone number, email)? *
How did you hear about CLLS? *
I understand that the Fall 2021 Seminar is virtual and understand the need for a computer, a good internet connection and am able to give my full attention to the three day seminar from 8:30 - 2:30 daily. *
What is one thing you are hoping to take from seminar and apply it to your leadership journey? *
Photo, Video Recording and Social Media Release
For good and valuable consideration, the receipt of which is hereby acknowledged, I (named herein) hereby GRANT / DO NOT GRANT Camp Lejeune Leadership Seminar permission to use my likeness in a photograph and/or video recording in any and all of its publications, including but not limited to all of Camp Lejeune Leadership Seminar’s printed and digital publications, website, and Facebook page. I understand and agree that any photograph and/or video recording using my likeness will become property of Camp Lejeune Leadership Seminar and will not be returned. I acknowledge that since my participation with Camp Lejeune Leadership Seminar is voluntary, I will receive no financial compensation. I hereby irrevocably authorize Camp Lejeune Leadership Seminar to edit, alter, copy, exhibit, publish, or distribute photo(s) and/or video recordings for the sole purpose of publicizing Camp Lejeune Leadership Seminar’s program and mission. 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 the photograph. I hereby hold harmless and release and forever discharge Camp Lejeune Leadership Seminar 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.
RESPONSE *
MCCS Hold Harmless Agreement
I (named herein) take full responsibility for any and all physical injury and inherent dangers while participating in the Fall 2021 Camp Lejeune Leadership Seminar and hold harmless the Camp Lejeune Leadership Seminar, non-profit corporations, its employees, staff, team leaders and its officers from any liability or any form that may result from any physical damages that may occur to me while participating in this event.
RESPONSE *
CLLS Virtual Hold Harmless Agreement
Having read this waiver and knowing these facts and in consideration for my registration, I as the registering participant, waive and release the Camp Lejeune Leadership Seminar, the executive board and all volunteers, as well as all affiliates and associates of this event, their representatives and successors from all claims or liabilities arising out of my participation in the Camp Lejeune Leadership Seminar virtual event for Fall 2021. I hereby waive my ability to bring any legal actions against the entities outlined in this waiver as I am voluntarily electing to participate in this virtual event by my own choosing. I grant permission to all of the foregoing to use my photographs and/or video and audio recordings of event participant, or any other record of this event, for legitimate purposes only.
RESPONSE *
DISCLAIMER
Camp Lejeune Leadership Seminar (CLLS) is not affiliated with, maintained, authorized, endorsed or sponsored by the United States Marine Corps or any of its affiliates.
A copy of your responses will be emailed to the address you provided.
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