Registration
Event Name
Email
Email Type
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Personal
Work
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Text Messaging
Phone Number
Phone Number Type
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Mobile
Home
Work
Text messaging will be used to communicate time-sensitive information, last minute changes and other updates associated with the Empowered event for which you are registering.
Please note, you are only opting into text messaging for this event.
Yes
No
I authorize Empowered to contact me via mobile text messages for communications related to a single event. Summary Terms & Conditions: Our mobile text messages are intended for subscribers over the age of 13. You may receive up to 4 messages per month between now and the end of the day of the event. Messages and data rates may apply. Opt out any time by texting the word STOP.
Which best describes you?
Educator/Facilitator
Administrator
Community Member
Donor, Business Owner, Volunteer, etc.
First Name
Last Name
Home Address - please complete all fields
Country (must be completed prior to state)
Street Address
City
State (no abbreviations)
Zip Code
School/
Organization
School
/Organization
Unable to find Organization or School in the list (ensure box above is empty)
School
Organization
School Name
Organization
Name
How did you hear about Empowered?
Please select...
Empowered Representative or Educator
YEAcademy.org
YouthEntrepreneurs.org
Conference or Other Event
Education Website
Google Search
Social Media
Online Ads/Youtube/News Feature
Word of Mouth
Other
Empowered Representative or Educator who referred you:
Terms and Conditions
I have read and agree to the
Empowered Privacy Policy
.
I understand that the event and my participation in the event will be recorded, and I consent to such recording.
I consent to Empowered’s use of my name, likeness, quotations and testimonials and similar characteristics for the purpose of advertising, selling, or otherwise promoting Empowered. I understand and agree that there will be no financial or other monetary compensation for such use.
Image Release
. Photographs and/or audio/video recordings taken at the event by Empowered, or others on behalf of Empowered, may include a participant’s image, name, voice and/or likeness. By attending and/or participating in the event, participant hereby grants Empowered
and
its
affiliates,
licensees,
successors,
assignees,
designees,
grantees
and
any
entities
or
persons
acting
on
behalf
of
any
of
the
foregoing
permission to use, the participant’s photograph, image, likeness, voice and statements for any purpose, including, without limitation, commercial purposes, without compensation or credit to the Participant, in any and all media now known or hereafter devised.
I consent to Empowered collecting, processing and using the personal data I supplied in this application in order to review my materials and communicate with me about the application and event.
Be sure to review the applicable
Empowered Privacy Policy
for more information about how Empowered collects and uses personal data.
Empowered reserves the right to cancel, modify, or suspend event for any causes beyond the control of Empowered that impact the effective administration, proper conduct or integrity of the event.
Terms and Conditions
·
By clicking below, I agree to these Terms and Conditions and that the information in my registration is accurate, I have the rights necessary to share the materials contained in this registration, and my registration will not infringe on any third party’s rights or violate any applicable laws. If you have any questions about the Event,
please reach out to
hello@empoweredhq.org
I agree
Contact Information