Name *

First Name

Last Name

Phone

(###)

###

####

Checkbox *

I, the undersigned, voluntarily agree to participate in the above-listed event hosted by Michelle Briehler, including any affiliated companies, representatives, or individuals involved. I understand that physical activity carries inherent risks, and I affirm that I am in good physical condition and able to participate. I accept full responsibility for any injury or health condition that may arise during or as a result of this event. If necessary, I will consult with my physician prior to participation. I also acknowledge that the event organizers are not responsible for any lost or stolen personal belongings during the event. Media & Marketing Release: By registering and signing below, I grant permission for any photographs or video footage taken during the event in which I appear to be used for promotional purposes. This may include, but is not limited to, social media posts, websites, or event marketing materials.

Yes

Marketing Release

Yes, I consent to media use

No, I do not consent