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Siebert Lutheran Foundation 2024
2024 Collaborators' Event
Registration
Contact Information
Name
*
Prefix
First Name
Last Name
Suffix
Please share how you would like to be recognized:
*
ie: John Smith; Mary and John Smith; Smith Family Foundation
Email
*
Verify Email
*
Phone
HOME Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Number of attendees
*
Please enter the number of guests (including yourself) that plan to attend the event.
Checkboxes
*
I wish to attend
Virtually
In-person
Guest 1
Prefix
First Name
Last Name
Suffix
Guest 2
Prefix
First Name
Last Name
Suffix
Guest 3
Prefix
First Name
Last Name
Suffix
Guest 4
Prefix
First Name
Last Name
Suffix
Guest 5
Prefix
First Name
Last Name
Suffix
Guest 6
Prefix
First Name
Last Name
Suffix
I would like my gift to remain anonymous
*
Siebert Lutheran Foundation is required to report all donations of $5K or more, including those who wish to remain anonymous, on our 990-PF.
Yes
No
Do you grant Siebert Lutheran Foundation permission to share your contact information with the grantee for the purpose of receiving a gift acknowledgement letter?
*
Yes
No
Media release: I agree to the terms of the media release from the Siebert Lutheran Foundation, as described below
*
For consideration herein acknowledged as received, and by signing this release (“Release”), the undersigned on the undersigned’s own behalf and on behalf of any minor child identified below hereby gives the Siebert Lutheran Foundation permission to use the Content in any Media for any purpose (except pornographic or defamatory). I, on my own behalf and on behalf of any minor child listed below, agree that the Content may be combined with other images, text, graphics, film, audio, audio/visual works; and may be cropped, altered or modified. For the purposes of this Release, Content includes, but is not limited to, images, graphics, video recordings, and audio recordings featuring my image/likeness or that of my minor child identified below. Media may include, among others, advertising, promotion, and marketing materials created by or for Siebert Lutheran Foundation. I, on my own behalf and on behalf of any minor child listed below, agree that I and any minor child listed below have no rights to the Content and/or Media, and all rights to the Content and/or Media belong to the Siebert Lutheran Foundation. I acknowledge and agree that I and any minor child listed below have no further right to additional consideration or accounting, and that I and any minor child listed below will make no further claim for any reason to Siebert Lutheran Foundation. I acknowledge and agree that this release is binding upon my heirs and assigns and on any minor child listed below and such minor’s heirs and assigns. I, on my own behalf and on behalf of any minor child listed below, agree that this release is irrevocable and governed by the laws of the State of Wisconsin. It is agreed that my personal information and that of any minor child listed below will not be made publicly available but may only be used directly in relation to the licensing of the Content where necessary and may be retained as long as necessary to fulfill this purpose. I represent and warrant that I am at least 18 years of age and have the full legal capacity to execute this release. If I am executing this release on behalf of a minor child, I represent and warrant that I am the parent or legal guardian of such minor child and have full legal capacity to execute this release on behalf of such minor child.
Yes
No
