4th Annual Day of Dyslexia October 15, 2022
Please submit one registration per participant.  Registration fee will be $25 (after you complete this registration form, please use the link at the end to pay via Eventbrite).  *If you will be attending virtually, the link will be sent, along with a QR code to Wakelet, on Thursday, Oct. 13th for registered participants.
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Please indicate how you will participate in the Day of Dyslexia event. (All options have the same fee of $25.) *
I am a member of the International Dyslexia Association. *
I am interested in volunteering for the NC branch of the IDA to raise awareness of dyslexia.  Please contact me to discuss. *
Please add me to the IDA NC Newsletter mailing list
Will you help support IDA and those with dyslexia by making a donation?
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I hereby grant The International Dyslexia Association and IDA NC  (referred to as "Association") the irrevocable right and permission to use photographs and/or video recordings of me on the association webpage and other websites and in publications, promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me. 

I understand and agree that such photographs and/or video recordings of me may be placed on the Internet.  I also understand and agree that I may be identified by name and/or title in printed, Internet or broadcast information that might accompany the photographs and/or video recordings of me.  I waive the right to approve the final product.  I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof, and all plates, negatives, recording tape and digital files are and shall remain the property of the Association. 

 I hereby release, acquit and forever discharge the Association, its current and former board members, agents, officers and employees of the above-named entities from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below.  This release is binding on me and my heirs, assigns and personal representatives.

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