2022 Empowered Rise Up Registration – Mississippi June 6 & 7

Registration

Please complete the information below to register for our June 6 & 7, 2022 Rise Up event at Millsaps College in Jackson, Mississippi. If you have questions about the event before you register, please reach out to hello@empoweredhq.org. Thanks for registering and we look forward to seeing you this summer.


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I authorize Empowered to contact me via mobile text messages for communications related to Empowered.  Summary Terms & Conditions: Our mobile text messages are intended for subscribers over the age of 13.  Messages and data rates may apply.  Opt out at any time by texting the word STOP.
Personal Information

Please list any dietary restrictions due to an allergy, sensitivity, disease, or other health related issue or religious beliefs.

Please list any dietary preferences or lifestyle choices such as specialty diets, vegetarian, vegan, gluten free, keto, etc.

Empowered Staff may contact you further to discuss this.

Empowered Staff will contact you prior to the event to confirm if these services can or cannot be accommodated.

Hotel Scholarship


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Terms and Conditions

By submitting this application for Empowered Rise to Empowered, I (“you”, “my”, “me”, “applicant”, "registrant" and “participant”) acknowledge and agree to the following Terms and Conditions.

  1. I have read and agree to the Empowered Privacy Policy (https://teachempowered.org/privacy-policy).
  2. 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 (https://teachempowered.org/privacy-policy) for more information about how Empowered collects and uses personal data.
  3. 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.
  4. I understand all plans, ideas, designs, information, drawings, artwork, web sites, storyboards, images, names, logos, slogans, domain names, advertising materials, written documents, surveys, research, sketches, models, samples, tools, specifications, advertisements, computer programs, technical or business information or data, and work product of any kind and in any form, whether complete or incomplete, generated in connection with the Event (the “Materials”), and all present and future intellectual property rights related to the Event, created by me on Empowered’s behalf will be exclusively owned by Empowered.  Empowered may exercise any and all rights granted in or contemplated by this Section without any right of review or inspection by me, without any additional consent or authorization from me, and without any compensation to me. Empowered grants to me a non-exclusive, perpetual, royalty-free license to use, copy, modify, adapt, and create derivative works from the Materials unless it contains any material that is owned by Empowered (for example, Empowered trademarks) outside of the scope of the Materials. For the avoidance of doubt, Empowered does not grant to participant any license to any trademarks or copyrights owned by Empowered other than as described above.
  5. The Registrant understands that there are certain risks inherent in any travel, especially out-of-state, and does hereby release Empowered, its Directors, staff, or any other person, organization, or entity assisting with the event from liability for any injuries, illnesses, or medical expenses Application may incur traveling to, from and during the event.
  6. COVID-19. Empowered is not requiring applicants to be vaccinated for COVID-19 or show proof of vaccination, and it is up to each applicant to stay up to date with the latest travel guidelines for their respective areas. I understand that my participation in the event is voluntary, and I agree that I will not participate in the event unless I am healthy enough to do so. Specifically, but without limiting the foregoing, I agree that I will not participate in the event if, within the last 14 days, I have: (a) engaged in any international travel, (b) been exposed to any person returning from any international travel, (c) been exposed to any person who has a suspected or confirmed case of COVID-19, or (d) been diagnosed with or displayed any symptoms of COVID-19. I also agree to cooperate with Empowered so that the event may be held safely and in compliance with COVID-19 related regulations (mask requirements, minimum distance requirements, etc). 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.
  7. You are responsible for any tax liability associated with the receipt of funds. The following documents are to be provided prior to receipt of funds:

    • IRS form W-9 Request for Taxpayer Identification Number and Certification
    • ACH Payment Authorization – used to set up direct deposit into a bank account


By clicking the box below, I agree to these Terms and Conditions and that the information in my application is accurate, I have the rights necessary to share the materials contained in this application, and my application 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