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Connect With A Colleague ("CWAC") Contest Entry Form

Georgia lawyers may submit up to five (5) separate entries, one for each new connection. Each person who "connected" must enter separately.
1.Last Name of Person Completing the form and entering the contest(Required.)
2.First Name of Person Completing the form and entering the contest(Required.)
3.Middle Name or Initial of Person Completing the form and entering the contest. (Please enter None or N/A if you do not have a middle name or initial)(Required.)
4.Email Address of the person completing this form and entering the contest(Required.)
5.Employer (the Committee will give special recognition to the legal organization that has the most attorneys from their office who participate in the contest):(Required.)
6.First and last name of the colleague with whom you connected(Required.)
7.Date that you and your colleague connected(Required.)
8.Name of venue where you and your colleague connected(Required.)
9.City, State (and Zip if Available) where you and your colleague connected(Required.)
10.Please upload a photo (in JPEG, JPG, or PNG) of you and your colleague connecting (File size limit is 16 MB)(Required.)
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11.I certify that is my first social interaction with my colleague(Required.)
12.By agreeing to participate as a contestant in the Connect With a Colleague Contest, I give the Chief Justice’s Commission on Professionalism (CJCP) and the State Bar of Georgia the right to photograph, videotape, or otherwise record or collect my name, image, likeness, voice and sounds (“Works”). I irrevocably assign and grant to CJCP and the State Bar of Georgia all rights in these Works and the right to publish, display, reproduce, and otherwise use or license others to use these Works and my name and other identifying information, in CJCP or the State Bar of Georgia’s discretion, in all media and for any purpose, including without limitation, advertising and other promotions for CJCP and the State Bar of Georgia, without any further consideration to myself or my heirs, assigns, or legal representatives, and without any right to review any such use beforehand.(Required.)