Name
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First Name
Last Name
Legislative Office
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Email
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Phone
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of Arrival
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Programming will begin on 12/3 at 11:00 am PT
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Date of Departure
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Programming will end on 12/4 at 7 pm PT
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Will a guest attend with you? If so, please list his or her name here
Do you or your guest have any food allergies or dietary preferences?
WAIVER OF LIABILITY, RELEASE, AND CODE OF CONDUCT
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I understand that by participating in travel and events related to the Legislative Leaders Summit (“Summit”) and while traveling for the Summit (the “TRAVEL”), I may be exposed to a variety of hazards and risks—foreseen or unforeseen—which are inherent in such participation and cannot be eliminated without destroying the unique character of the Summit. These inherent risks include, but are not limited to, the dangers of traveling to and within the city in which the Summit takes place that may result in serious illness, physical injury, disability, or death (“Injuries and Damages”). I understand that Injuries and Damages can occur by natural causes or activities of other participants and/or third parties, whether as a result of negligence or otherwise. I understand and acknowledge the risk of such Injuries and Damages, and I fully acknowledge that no employee or representative of American Federation for Children Growth Fund (AFC-GF) has tried to contradict or minimize my understanding.
IN CONSIDERATION of being permitted to participate in the TRAVEL, THE UNDERSIGNED, for myself, my personal representatives, heirs, and next of kin agrees as follows:
I HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE AFC-GF and its directors, officers, agents, employees, representatives, successors, affiliates, along with each of their respective sponsors, promoters, and volunteers, and all other participants of the TRAVEL (collectively referred to as the “Released Parties”), FROM ALL LIABILITY TO THE UNDERSIGNED, and to the UNDERSIGNED’s personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE TRAVEL, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES OR OTHERWISE.
I HEREBY AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Released Parties and each of them FROM ANY LOSS, LIABILITY, DAMAGE, OR COST they may incur arising out of or related to the TRAVEL, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES OR OTHERWISE.
I HEREBY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to the TRAVEL, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASED PARTIES OR OTHERWISE.
I HEREBY AGREE that this Release extends to all acts of negligence by the Released Parties and is intended to be as broad and inclusive as is permitted by the laws of the State in which the TRAVEL is conducted. If any portion thereof is held invalid, I FURTHER AGREE that the balance shall, notwithstanding, continue in full legal force and effect.
I HAVE READ THIS WAIVER OF LIABILITY, RELEASE, AND CODE OF CONDUCT. I FULLY UNDERSTAND ITS TERMS AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT.
I FULLY UNDERSTAND THAT BY SIGNING THIS WAIVER OF LIABILITY, RELEASE, AND CODE OF CONDUCT, I FREELY AND VOLUNTARILY GIVE UP MY RIGHTS TO ANY FUTURE CLAIMS OF LIABILITY AGAINST THE RELEASED PARTIES FOR ANY ILLNESS, BODILY INJURY, DISABILITY, DEATH OR PROPERTY DAMAGE THAT MAY RESULT FROM MY PARTICIPATION IN THE TRAVEL. I HAVE SIGNED THIS RELEASE FREELY AND VOLUNTARILY, WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME, AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE TO THE GREATEST EXTENT ALLOWED BY LAW.
CODE OF CONDUCT. I hereby agree and acknowledge that, as an attendee of AFC-GF’s Legislative Leader’s Summit: (i) I have reviewed the applicable ethics rules of my state pertaining to gifts, travel, and entertainment; (ii) I have reviewed the obligations and restrictions, if any, required by my state as they relate to the acceptance of certain gifts; (iii) I agree to abide by all reporting and disclosure requirements as mandated by my state; (iv) and, I will not accept anything, of value or otherwise, that is impermissible, and will notify legal counsel in the event of any question relating to such rules. I further hereby acknowledge and agree to maintain professionalism during the Summit and to abide by this Code of Conduct set forth above and in accordance with all applicable law.
