Confirmation Form

Complete the below form for SVA's Leadership Institute 2024 event.

Student Veterans of America®

The Leadership Institute Confirmation Form

First Name

Last Name

Phone

Are you attending the event?

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Shirt Size

Preferred Departing Airport

By selecting this box you agree to the below statement

I understand that I will be sharing a hotel room with one student veteran during the Leadership Institute program experience.

By selecting this box you agree to the below statement

CONSENT FOR USE OF IMAGES AND VIDEOS (v10.19.23) I the undersigned Releasor, hereby grant to Student Veterans of America and its affiliated companies, successors and assigns full right and unrestricted permission to use and reuse my “likeness, voice, name, spoken words and written statements” (my “Persona”) and to use and reuse, publish and re-publish in whole or in part, individually or in conjunction with other work, my work entitled or referred to as the “Work”, if applicable. My Persona (including any Statement, defined below) and Work may be used in any form or through any media whatsoever, including without limitation, photographs, illustrations, pictures, video recordings, audio recordings, audio-visual recordings, or any media now known or hereafter to be developed, or with any intentional or unintentional alterations or distortions, for advertising, publicity, art, promotion or other commercial purposes. I hereby release, acquit and forever discharge the Organization, its agents, assigns, officers, directors, employees, parents, subsidiaries, and affiliates from any and all claims or liabilities arising as a result of any use of the Word, Statement, or Persona in any medium. This release shall be binding upon my respective heirs, executors, licensees, legal representatives and assigns. I hereby waive any right to inspect or approve, and understand and acknowledge I have no ownership interest in, the finished product of materials created in accordance with this document, or the advertising copy or other material that may be used in connection with such product or materials, or the uses to which it may be applied. I represent and warrant that any statements I have provided to the Organization (“Statement”): i) reflect my honest and truthful beliefs and opinions, ii) are based on my personal experience with the organization, iii) have been given voluntarily, and iv) were developed prior to becoming aware that the Organization may use them or compensate me for them, if applicable. If at any time my opinion in my aforementioned Statement changes, I will notify the Organization in writing at the address listed on the Organization's website, to the attention of General Counsel. I also understand that someone may contact me from time to time to ensure I still hold the opinion contained with the Statement. I understand that I have no right to approve the advertising or materials created pursuant to this release and that the Organization is not obligated to use the Work, Statement, Persona, or information relating to me in any manner or respect. I warrant that I am at least 18 years old (or that I have the consent of a parent or guardian as indicated below), that I have the right to execute this release in my own name, that I have read the above authorization prior to its execution, and I am fully familiar with the contents thereof.

Today's Date

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