Save a Life Registration

Please complete the form below

Question, Persuade, Refer Training

Name

First Name

Last Name

Age

Gender

Race

Education Level

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you served, or are currently serving in the US Military (i.e. Active Duty, Guard, Reserve, or Veteran)?

Do you have any children (under 18) in your home regularly?

Dietary Restrictions

Ex: Nut, Soy, Dairy, Shellfish, etc. (If there are no restrictions, put NONE)

How did you hear about this event?

I acknowledge that in attending WhitneyStrong’s Save A Life event I may be in proximity with people who may be carriers of the COVID-19 virus, and I agree that WhitneyStrong shall have no legal responsibility for any illness I may have in the future.

Photo-Release Policy

By acknowledging and agreeing to the Publicity Permission and Consent policy, you give permission and consent for WhitneyStrong, Inc., to use your name, image, voice, and appearance in any photographs, video recordings, audio recordings, and digital images taken or made on behalf of WhitneyStrong or in connection with any activity of WhitneyStrong. This Publicity Permission and Consent shall remain in full force and effect unless canceled in writing and reasonably in advance of any publication.

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