Summit Guide Registration

Name *

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Will you have medical insurance at the time of the summit? *

Yes

No

I hereby grant Magic Wand Foundation the irrevocable right and permission to use photographs and/or video recordings of me at the Ultimate Life Summit in publications, promotional flyers, educational materials, derivative works, social media, or for any other similar purpose without compensation to me. I understand and agree that such photographs and/or video recordings may be placed on the Internet. I also understand and agree that I may be identified by name and/or title in printed, Internet or broadcast information that might accompany the photographs and/or video recordings. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof, and all plates, negatives, recording tape and digital files are and shall remain the property of the Magic Wand Foundation. I hereby release, acquit and forever discharge the Magic Wand Foundation, the 7 Mindsets Corporation, the Ultimate Life Summit, its current and former trustees, agents, officers, sponsors and employees of the above-named entities from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.

I agree and consent to the Photo & Video Release terms above.

I do not agree to the Photo & Video Release terms above.