TitleMr.Mrs.Ms.RabbiDr.Rabbi Dr.Dr. RabbiSirThe HonorableChaplainName* First Last Organization*Please SelectOU OfficerOU Board MemberOUA CommitteeSynagogue LeaderSchool LeaderTeach Coalition LeaderOtherPlease specify* Email* Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Registration Type Registration/Attendance Fee for Tuesday evening dinner and Wednesday program - $415 Registration/Attendance Fee for Wednesday only - $325 Dietary restrictions/allergies Total $0.00 ORTHODOX UNION MEDIA RELEASE Please read this media release and sign electronically below. In consideration of the right for me to participate in Orthodox Union events and other good and valuable consideration, I – on behalf of myself and my heirs and assigns – hereby agree as follows: I irrevocably authorize The Union of Orthodox Jewish Congregations of America, and its subsidiaries, affiliates, officers, directors, agents, employees, successors and assigns (together, “(“Orthodox Union”) to photograph, film, videotape, record, reproduce, portray, and otherwise use my appearance, voice, name, biographical information, image, and actual or simulated likeness (collectively, “Likeness”), and to use the results thereof, including all video and audio recordings, photographs, and film or any other media secured by, produced by or on behalf of the Orthodox Union that incorporates any of the foregoing (collectively, “Recordings”), for any purpose whatsoever, including on its social media pages, all without further obligation or compensation. The foregoing rights extend to all media, in all forms, now known and hereafter devised, throughout the universe and in perpetuity, including in connection with publicity and advertising. I shall have no rights of review or approval regarding the Recordings and the Orthodox Union shall have the right to edit or delete those Recordings in their sole discretion. I understand that all rights in and to the Recordings shall be Orthodox Union’s sole and absolute property. I release and forever discharge the Orthodox Union from all causes of action, suits, or damages and liability of any kind arising from or in connection with the use or publication of any Recordings of me made in connection with my participation in events. I waive any right of privacy associated with my Likeness and I waive any right to compensation related to the use of my Likeness. I HAVE READ THIS AGREEMENT AND AM FULLY AWARE OF ITS CONTENTS, INCLUDING THE RELEASE, I HAVE AGREED TO HEREIN. I warrant that I am at least eighteen years of age (or, if not, that my parent or legal guardian has agreed to the foregoing and signed below) and that I have the full, complete, and unrestricted right and authority to enter into a contract for myself (or, if not, that my parent or legal guardian has agreed to the foregoing and signed below), and on behalf of my heirs and assigns. If any provision of this agreement is held to be unenforceable, the remainder of it shall continue to be in full force and effect. Media Release* I consent to the above media release Please print your signature*