Form cover
Page 1 of 1

WIN with Courage June 3rd Celebration

What is your full name?

What agency are you wtih?

Will you attend in person?

Will you attend in person?
A
B

Are you a member of another BRG(s) if so, please list it here. If no please write N/A

By registering for this event, you grant permission for photographs and/or video recordings to be taken of you and used for promotional, educational, or informational purposes, including websites, social media and other communications.

By registering for this event, you grant permission for photographs and/or video recordings to be taken of you and used for promotional, educational, or informational purposes, including websites, social media and other communications.
A
B