Celebration of Community Impact in Edmonton
Form Submitted Date:
Ensure the custom code is copied to the Form Properties
Please join us on
Wednesday
December 2nd
from
6:00pm – 8:00pm
at
Lexus of Edmonton
for an evening of appreciation and connection. Complete your registration below to confirm your attendance for the Celebration of Community Impact in Edmonton.
First Name
Last Name
Email Address
What is your preferred language of communication?
English
French
Communications:
Yes, I would like to receive communications about the impact of my support and updates on MS Canada
Yes, I would like to receive SMS communications about the updates from MS Canada
Mobile phone number:
Will you be attending the event?
Yes
No
Will you be bringing a guest?
Yes
No
Guest First Name
Guest Last Name
Guest Email Address
Please enter your guests emails address, we will contact them to complete their registration.
If applicable, please list any dietary or accessibility needs:
*
I consent to use of my personal info by MS Canada for purposes outlined in our
privacy statement
.
*
I acknowledge that I understand the intent thereof, and I hereby agree to absolve and hold harmless the MS Canada, corporate sponsors, co-operating organizations and any other parties connected in any way, singly or collectively (the "Parties”), from and against any blame and liability for any injury, misadventure, harm, loss, inconvenience, or damage hereby suffered or sustained as a result of my involvement with MS Canada as an event participant except where such claims are solely caused by the Parties negligence or willful misconduct.
*
I give full permission for use of my name, any photographs or videotape images of me taken in the course of my involvement and I understand that it may be used for publications such as MS Canada annual reports, newsletters and online.