THERE IS NO PRE-REGISTRATION.  DO NOT MAIL.


MERRY TUBACHRISTMAS® REGISTRATION
2007 PARTICIPANT REGISTRATION & WAIVER FORM
Please print legibly - Use home address - Do not abbreviate - Please complete - DO NOT MAIL

TUBACHRISTMAS City: ________________________________________

Is this your first TUBACHRISTMAS?   YES

NAME:First__________________ M.I._____Last_______________________________  

ADDRESS:______________________________________________________________

CITY:_______________________STATE:_____ ZIP:____________      All checks payable to TUBACHRISTMAS-HPF

EMAIL ADDRESS:______________________________________________

Is the above a change of name or address for the TUBACHRISTMAS mailing list?  YES
PREVIOUS NAME _____________________________
ADDRESS  __________________________________________  CITY/STATE/ZIP _________________
When/if your address changes, please notify TUBACHRISTMAS - P.O. BOX 933 - BLOOMINGTON, IN 47402-0933
or email participant@tubachristmas.com. - VISIT OUR WEBSITE at www.TUBACHRISTMAS.com

WAIVER: Date: _________________ SIGNATURE: I______________________, have hereby provided the information requested above and have affixed my signature thereby waiving any right of publicity, privacy or copyright in the performance and my appearance and participation in same, and grant royalty free worldwide transferable license of any portion of the performance, to use my name, likeness, and any copyrighted material for the purposes deemed appropriate by Harvey G. Phillips, founder and president of The Harvey Phillips Foundation, a not-for-profit, tax-exempt 501(©) (3) corporation.

Please Note: All registration fees are tax-deductible donations to The Harvey Phillips Foundation, Inc., a not-for-profit, tax-exempt corporation.  TUBACHRISTMAS is a property and production of The Harvey Phillips Foundation, Inc., P.O. Box 933, Bloomington, IN 47402-0933.  TUBACHRISTMAS is used by permission; commercial exploitation is prohibited.

 

Print this form, fill in all information and bring with you to TUBACHRISTMAS registration.

THERE IS NO PRE-REGISTRATION.  DO NOT MAIL.