2. School Name*
3. School Address*
5. City*
6. State*
7. Zip Code*
9. Point of Contact Name*
10. Point of Contact Title*
12. Point of Contact Phone Number*
13. Point of Contact Email Address*
15. Date/Time of Event*
    Date/Time of Event

    Date/Time of Event
16. Location of Event *
    Please include address and zip!
18. Number of Student Participants *
19. Would you like to request a Workforce Solutions employee to speak at your event?*

    1. Yes
    2. No
21. Please enter any other businesses, organizations, or training partners participating in event:
23. Release
    By entering your name below, you agree that all Career Signing Day participants from your school are in compliance with your institution’s consent and release policies and authorize Workforce Solutions of West Central Texas (including any of its officers, employees, contractors and agents) to disseminate information about this event and its participants including the use of photograph, videotape, or film taken for the same purpose, including (but not by way of limitation) illustration, promotion, advertising, or trade. No compensation will be given. You also hereby release and discharge Workforce Solutions of West Central Texas and materials/photographs/videotape/film including any and all claims for libel.
    
    
25. First & Last Name*
26. Date*
    Date
28. Full Media Release Form
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field