Women Empowerment Network

Registration form for Women's Empowerment Network

* Please complete the following questionnaire. This information will be used for the organization’s data collection
purpose only and will not be shared to any other party.

Women Empowerment Networking 2021-22 New

> Additional Information

"I agree to release and waive all claims and hereby indemnify and hold harmless both MIAG Centre for Diverse Women and Families and their funders, officials, officers, employees, representatives, any affiliated agencies, volunteers and others participants for any and all liability or personal injury resulting to me or to any of person for whom I am in law responsible, from or connected with participation in any activity contemplated by this Registra-tion. I hereby further agree that the MIAG Centre for Diverse Women & Families and the Insured Persons shall not be liable, either directly or indirectly, for any claims, or any damages, costs and expenses respecting any act done in good faith, including but not limited to personal injury, death, property damage or loss resulting from or connected with participation in any activity contemplated by this Registration.”


I have read and understood the Waiver of Liability

I give permission to MIAG Centre for Diverse Women & Families to photograph/video me and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes. I further consent to the use of my name in connection with the photo-graph(s)/video(s) if needed. I understand and agree that I will not receive any payment for my time or expenses or any royalty for the publication of the photograph(s)/video(s) or the use of my name and I hereby release MIAG Centre for Diverse Women & Families as an organization, its staff, board of directors, funders, partners and volunteers from any such claims. I certify that I have read and fully understand this consent and that all questions pertaining to this consent have been answered to my satisfaction. I have read and understood the Consent to Photograph/ Video Release

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