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C CONTESTA ANT #s:

The easie est, most sec cure way to register r is at t www.iSING ToEndHome elessness.or rg!

Plea ase Print to complete entire e form legibly; l one e form per s soloist/band d or group m member. Yo ou can also mak ke an additio onal contrib butioneve ery bit helps s to end ho melessness s and empo ower familie es to move beyo ond their cr risis and ge et on a path to self-suff ficiency. Th hank you! 1. Re egistration C Competitive Audition A (All Ages) $25 (Soloist, Gro oups up to 4 members) C Competitive Audition A (All Ages) $20 (Groups ove er 4 member rs) Audition Day Reg gistration - $30 (PERK! Receive R up t to $5 OFF yo our day of registration by bringing can good 0 Off, 2 Can ds to donate towards our Food Pantry1 Can G Good = $1.00 n Goods = $2 2.00 Off, etc.) G GRAND FINA ALE (May 18th) Advanc ced Tickets $5 A Additional Do onation $ __ ________ Tota al $ _______ _______ Your r Name : (Your Ba and/Group N Name if applicable):

____ __________ ___________ __________ __________ ___________ __________ __________ ___________ ________ Phon ne________ __________ ___________ _____ Ema ail Address (requiredch heck for con nfirmation) __ __________ __________ ___________ __________ ________ Stree et Address_ ___________ __________ ___________ ___________ __________ ___ City/ /State/ Zip Code C ______ __________ ___________ __________ __________ ___ ______ Sex M / F_____ Date e of Birth (MM M/DD/YY) ___________ __ _____Age ___________ __ _ Genre of Music c you will be e performing: ________ __________ __________ ___________ ________ Curr rent Employ yer or Scho ool: ____ __________ ___________ __________ __________ ___________ __________ __________ ___________ _____ Does s your emplo oyer make matching m don nations? Y Yes, and her re is the cont tact informat tion: ____ __________ ___________ __________ __________ ___________ ___ N No N N/A

2.WaiverandAgreementInconsiderationofbeingpermittedtoparticipateinAGratefulMindsSingToEnd HomelessnessCharitySingingCompetition,Idohereby,formyselfandheirsandpersonalrepresentatives,releaseand dischargeAGratefulMindInternational,Inc.anditsassociatedpartners,companies;OrangeCountyGovernment,City ofOrlando;anyandallsponsors,theirrepresentatives,affiliates,agents,employees,officers,directors,successors, assigns,andallotherpersonsconnectedwiththisprogram,fromanyandallliabilitiesonaccountofanyinjury,death,or damagegrowingoutofmyparticipation,whethercausedbytheirnegligenceorotherwise.Iampsychologicallycapable andsufficientlytrainedtoparticipateinthisprogramandrecognizetherisksinvolved,andintendbythisreleaseto assumefullresponsibilityforanythingthatmighthappentome.IattestthatIamcurrentlynotlegallyboundorunder contractwithanyrecordingagent,studioorrecordlabel.Further,Iherebygrantfullpermissiontoanyandallofthe foregoingtouseanyphotographs,music,motionpictures,recordingsoranyotherrecordofthiseventforany legitimatepurpose,includingcommercialadvertisingwithoutmonetarypaymentorroyaltiestomeandanyfutureheir ordescendantofme.PARENT/GUARDIANWAIVERFORMINORS(Under18yearsold)Theundersignedparentand naturalguardiandoesherebyrepresentthathe/sheis,infact,actinginsuchcapacityandagreestosaveandhold harmlessandindemnifyeachandallofthepartiesreferredtoabovefromallliability,loss,cost,claimordamage whatsoeverwhichmaybeimposeduponorassociatedwithsaidpartiesbecauseofanydefectinorlackofsuchcapacity tosoactandreleasesaidpartiesonbehalfoftheminorandtheparentsorlegalguardian. _________________________________________________________________________________ Name Signature Date

3. Payment: Submit your Audition Registration form to A Grateful Mind Community Outreach Services by email at SING@agratefulmind.org . Our Paypal email is: mail@agratefulmind.com. Check/Money Order: Please make payable to A Grateful Mind International, noting SING and the Soloist, Group/Band name in the memo. Mail to: PO Box 721915 Orlando FL 32872-1915. Must be received by April 21st. Credit Card: You may fill out your BILLING information below, or call (407) 900-5558 to register securely by phone. Please note: all credit card registrations will encounter a $3 transaction fee. Name ____________________________________ Card Number ____________________________________________ Billing Street Address _________________________________________________________________ Billing City, State, ZIP __________________________ Exp. Date (MM/YY) __________ Security Code (XXX) _________ The event will proceed rain or shine. In the case of extremely inclement weather, refunds will not be provided. Thank you! See you at the Auditions on Saturday, April 26, 2014! Youwillreceiveaconfirmationemailwithinformationonhowtoaccessyourpersonalfundraisingpage.Pleasevisitthe websiteatwww.iSINGToEndHomelessness.orgforcompletemoredetails&anyupdatesonourCharitySinging Competition!