Royal Gold and White

Black & White Steppers Ball Feat. A $2,000 Heavy Hitter Steppin Contest Sunday, August 28, 2016 | Crowne Plaza Ravinia

Registration Form

Contestant 1 Name: Email: Phone:

Contestant 2 Name: Email: Phone:

For a complete list of contest rules please log onto http://www.thesteppersball.com/ContestRules.html

Project STEP LLC Dance Liability Release: I understand that there are risks of physical injury associated with and arising out of, and inherent to, the activity of dance. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/or causes of action of any kind, including any and all claims of negligence arising as a result of such activity from which liability could accrue to Project STEP LLC and its affiliates. I hereby agree to release Project STEP LLC and hold Project STEP LLC harmless of all liability, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for all risks of physical injury arising out of active participation in the Black & White Ball – HeavyHitter Steppin Contest. I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation.

I also agree to the capture and use of photographic images, video footage, film and sound recordings of the named participant, for use in the documentation, evaluation, promotion, marketing and publicity of Project STEP LLC. These images and recordings may be used, reproduced and distributed in print, electronically and mechanically, including via websites and e- mailings with no royalties to me.

Contestant 1 Signature Contestant 2 Signature

Sign and return to: Project STEP LLC, 2341 Springrun Way, Decatur, GA 30032...or simply by sending this document via email serves as an electronic signature confirming your understanding of the Contest Rules and Our Disclaimer. For questions or concerns, call Sarah Teagle at 404.931.1367. WAIVER OF LIABILITY AND MEDIA RELEASE AGREEMENT

IN CONSIDERATION for being permitted to participate in the Contest, THE UNDERSIGNED, for himself/herself, the organization, my personal representatives, heirs and next of kin:

I, (full name)______as an associate or representative of ______(organization/self) on this (date)______, do hereby grant permission to the undersigned Project STEP LLC, and its assignees to use images, audio and recordings for such use, including but not limited to, display, broadcast, distribution, publication, transmission, or otherwise use of recordings for use in materials that include, but may not be limited to, printed materials such as television, newsletters, videos, and digital images, social media such as those recording and affiliate web sites.

I grant unrestricted permission my image and video recordings of myself and my property to be used in broadcast, print, video, and digital media. ______(initial)

I understand and agree that my organization/self, will receive acknowledgement through verbal or rolling credits at the beginning, during, or end of the show (if aired or video recorded). ______(initial)

I understand and agree that these recordings may be used by the undersigned for a variety of purposes and that these recordings may be used without further notifying me. ______(initial)

I understand and agree that my first name and last name, city and zip code could be used in conjunction with any video or digital image recordings and on affiliate web sites. ______(initial)

I agree that I assume the risk of injury during my participation in the Contest; ______(initial)

I acknowledge that in the course of my participation in the Contest, video recordings or photographs may be taken or illustrations may be made of myself. I further agree to allow, without compensation, my likeness to appear in material, regardless of media form, promoting the recording, its events and activities, including those of its representatives, affiliates and licensees; ______(initial)

I agree that the foregoing release, waiver and agreement is intended to be as broad and inclusive as is permitted by laws of the State of Georgia and the United States of America and that if any portion thereof is held invalid, the balance shall continue in full legal force and effect. ______(initial)

I understand and agree that no compensation will be given or received for my participation in the recordings, photographs or illustrations. ______(initial)

I have read and voluntarily signed this Waiver of Liability and Media Release Agreement and further guarantee that no additional oral representations, statements or inducements have been made.

Contestant’s Signature