Please enable JavaScript in your browser to complete this form.First Name *Last Name *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *PhoneSelect your age range *Under 1515-1819-2526-3536-5455 and overChoose Your Time Slot *11am - 11:30am11:30am - 12pm12pm - 12:30pm12:30pm - 1pmMedia Release By checking the box below, I hereby consent and agree that the C&O Canal Trust, its employees, contractors, and/or agents have the right to take photographs and/or digital recording, and other images of me and/or the minor(s) under my supervision, and to use or exhibit them, or license them for use or exhibit by others in any and all media, now or hereafter known, for the purpose of furthering the mission of the C&O Canal Trust. I further consent that my name and identity and the name and identity of the minor(s) under my supervision may be revealed therein or by descriptive text or commentary. I do hereby release to the C&O Canal Trust, its agents, contractors and employees all rights to exhibit this work in print and/or electronic form, publicly or privately, and to market and sell copies. I waive any rights, claims, or interest I may have to control or to approve the use of my identity or likeness and/or those of the minor(s) under my supervision in whatever media used. I understand that there will be no financial compensation or other remuneration for recording me and/or the minor(s) under my supervision, either for initial or subsequent transmission or playback. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement. I further represent that I have the authority to grant the foregoing release on behalf of the minors identified below. *I agreeI do NOT agreeComment or MessageCommentSubmit
