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* 1. Organization Name

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* 2. Address (Street Address / City / State

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* 3. Event Manager Contact Information

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* 4. Marketing Manager Contact Information

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* 5. Your organization's Facebook page URL (leave blank if you don't have one)

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* 6. Your organization's Twitter handle (leave blank if you don't have one)

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* 7. Your organization's Instagram handle (leave blank if you don't have one)

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* 8. Your organization's web address

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* 9. What date(s) do you intend to host a National Blind Sports Day event

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* 10. Where will the event be held? Please provide address if known.

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* 11. How many participants do you anticipate to attend your event?

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* 12. What activities/sports do you plan on coordinating for the event?

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* 13. Would you like assistance from USABA in identifying a keynote speaker for your event?

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* 14. National Blind Sports Day Waiver Agreement
I, for myself and on behalf of my organization, hereby release, hold harmless and promise not to sue the United States Association of Blind Athletes (USABA), their officers, officials, agents and/or employees, with respect to any such injury, paralysis, dismemberment, death and/or loss or damage to property except that which is the result of gross negligence and/or wanton misconduct with involvement in the National Blind Sports Day event. By selecting “We agree’ to this statement, our organization recognizes that our organization is solely responsible to ensure the safety and protection of all athletes, volunteers, staff and attendees participating at our organization’s National Blind Sports Day. This responsibility includes, but is not limited to, the confirmation of clear and current background checks and relevant safety training to all applicable employees and volunteers.
USABA encourages all employees and volunteers with direct supervision over athletes to complete the US Center for Safe Sport’s training procedures (www.safesport.org) . We hereby authorize and give our full consent to USABA to copyright and/or publish any and all photographs, videotapes and/or film in which participants from our National Blind Sports Day event appear. We further agree that USABA may transfer, use or cause to be used these photographs, videotapes or films for any exhibitions, public displays, publications, commercials, art and advertising purposes and television programs without limitations or reservations.
By writing 'We agree' in the box below, this is to certify that I, dully authorized representative of our organization, have read and accept this Waiver Agreement. I agree to the rules, guidelines, jurisdiction and procedures stated in these documents as a condition of our organization’s participation in National Blind Sports Day.

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