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Application Form
Name ______________________________________________ Address ____________________________________________ City _________________________ State_______ Zip _____________Telephone Number ( ) ___________________________ Email address ________________________________ Age ______ Gender ________ Release Form: While I understand that National Right to Life Educational Trust Fund will take reasonable steps to provide for my individual safety, I am aware that NRLETF and its employees or agents cannot assume any responsibility for any injury, damage, or harm which might result during the course of participation in any activity connected to the National Right to Life Academy.In consideration of my participation, I agree that such responsibility will remain with me. Should any claim be asserted by any person, as a result of my acts while participating in the activity described above, or traveling to, from, or part of such activity, or should I assert any claim against NRLETF or its employees or agents, I agree to indemnify and hold NRLETF and its employees or agents harmless from any such claim, including attorney fees and costs incurred in defense thereof. Signature __________________________________________________________________________ Name Printed _______________________________________________________________________ Date ________________________________ Please attach the following three items:
Deadline for a $500 deposit is March 16, 2009. Deadline for payment of the $2700 balance will be established. Please mail registration form with check payable to: National Right to Life Academy, attn: Jacki Ragan, 512 – 10th St. NW, Washington, D.C. 20004. All applicants are subject to approval by the National Right to Life Ed Trust Fund. We reserve the right to refuse applicants who, in our opinion, do not reflect the character of the National Right to Life Academy. For more information please contact nrlcacademy@gmail.com.
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