Mississippi Point of Contact:

If you are in Mississippi and would like to become a Point of Contact for Coordination. Please fill the form below:

Mississippi Point of Contact

If you are in Mississippi and would like to become a Point of Contact for Coordination for Roar 4 Change.

Name(Required)

First Last

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Consent(Required)

I agree to the volunteer waiver as outlined.

I have agreed to serve as a volunteer Point of Contact for Roar 4 Change (R4C), and I fully understand, appreciate and assume all of the risks associated with my volunteer duties. I understand that my execution of this Waiver is a precondition to my serving as a volunteer.

1. I voluntarily release and hold harmless R4C, its board of directors, officers, employees, agents and other volunteers (collectively, "Releasees") from any and all claims, causes of action and damages and injuries of any and every sort, including but not limited to bodily injury or death which I may directly or indirectly suffer or incur as a result of, or in any manner arising from, my participation as a R4C volunteer, even if such claims, causes of action damages or injuries result from the negligence or conduct of one or more Releasees. I understand that by signing this Waiver I am waiving any rights that I may have to recover damages and legal or equitable relief of any sort arising in any way from my volunteer activities for R4C.

2. I hereby grant to R4C without charge the right to use, in any way that R4C may in its sole discretion deem desirable for the benefit of R4C, my image (whether photographic or otherwise recorded or transmitted) and work product arising from my volunteer activities for R4C.

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baljit

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Roar 4 Change