MERRY TUBACHRISTMAS® REGISTRATION
2007 PARTICIPANT REGISTRATION & WAIVER FORM
Please print legibly - Use home address - Do not abbreviate
- Please complete - DO NOT MAIL
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.
Print this form, fill in all information and bring with you to TUBACHRISTMAS registration.
THERE IS NO PRE-REGISTRATION. DO NOT MAIL.