: Staff of Adult MWLS 2019

YOUR INFORMATION
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Username
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Password
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Confirm Password
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First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Confirm Email:
Phone:
Cell Phone:
Nickname (optional - for name badge):
What pronouns do you use for yourself?:
Congregation:
Leadership Role with your congregation::



NOTE: Due to the College’s housing system, we must house people in the male/female gender binary. Please indicate with which gender you feel the most comfortable being housed.
With which gender group would you feel most comfortable being housed?:
female  male  
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Please describe physical accessibilty needs, if any::
Food preference - check all that apply:
OmnivoreVegetarianVeganGluten-Free
Please list allergies, if any (If NONE, leave BLANK)::
T-shirt Size:
SmallMediumLargeXLarge2XL3XL4XL

Emergency Contact Name:
Relationship:
Main Phone:
Additional Phone:

PHOTO RELEASE:
The undersigned hereby authorizes or ratifies MidWest Leadership School (MWLS) and/or Youth MWLS (YMWLS), their agents or employees, to use my photographic/video images for purposes of publicity and other promotional, non-profit uses.
This consent extends to the editing of the images to the extent necessary for normal production purposes, provided that the intent of the images is not altered.
This consent shall act to expressly release from liability MWLS/YMWLS and the component parts as well as its employees. The meaning and purpose of this consent has been fully explained to me.
If I consent, I will type my signature in this box. If I do NOT consent, I will type DO NOT AUTHORIZE.
Photo release signature:
Comments:
I agree to the terms and conditions:  
 Read Terms & Conditions
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