Real Connections 2017 Registration Name *If your organization requires that you pay by check, please complete this form and contact our event partner, J. Murphy & Associates, to assist with payment by check: 612-746-4150. Please note, each individual attending the event will need to complete this form. *After the registration is complete, please contact our event partner, J. Murphy & Associates, to reserve lodging and/or meals. Call Caroline or Bev at 612-746-4150. Reservations are available Monday-Friday 10 a.m.-3 p.m. First name * Last name * Organization/company * Membership level * Non-member Individual Member Ally Member Partner Program Email * Phone * Address 1 * Address 2 City * State/Territory * ZIP * Accessibility and Dietary Needs or Restrictions Permission to be photographed * I grant MNCASA unrestricted permission to publish and republish, in whole or in part, any photographs or videos in which I appear as a result of attending Real Connections 2017, in any media now or hereafter known, including the internet, and for any purpose including illustration, promotion, and editorial, without restriction as to alteration; and to use my name in connection with any use, if MNCASA desires. I understand that these images may be used in professional messages regarding sexual assault resources and prevention. I release and discharge MNCASA from any claims and demands that may arise out of or in connection with the use of the images, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of legal representatives, licensees, and assigns of MNCASA. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns. I decline to be photographed or captured on video, and agree to alert MNCASA staff upon check-in at Real Connections 2017 to obtain an opt-out badge, and to wear the opt-out badge to aid photographers in avoiding capturing and publishing my image. Please choose one I plan to stay in Mankato I plan to commute By clicking the above, you will be able to pay your Real Connections registration fee electronically and receive instructions to make your lodging payment.