Presidential Reception and Dinner in Buffalo, NY

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*Fields marked with an asterisk () are required.** First Name* Preferred First Name (if different) Last Name* Maiden Name Please note that a birthdate is required for record matching purposes. If you do not know the birthdate for a member of your party, please contact (412) 396-6209 for registration assistance: Birthdate* Birthdate* Email Address* Mobile Phone Number* Please check all of your Duquesne affiliations.* Please check all of your Duquesne affiliations.* Alumni Current Employee Current Student Current Parent Prospective Parent Prospective Student Past Parent Friend School Counselor No Affiliation Title* School Name* What is your hometown?* What is the name of your current high school?* What is your area of interest at Duquesne?* What is your current address?* Do you have a relative who is a Duquesne alumnus/a? If so, please list their name, graduation year, and major below. Preferred Class Year:* Please check preferred school.* Please check preferred school.* Palumbo-Donahue School of Business School of Education John G. Rangos, Sr. School of Health Sciences Thomas R. Kline School of Law of Duquesne University McAnulty College and Graduate School of Liberal Arts College of Osteopathic Medicine Mary Pappert School of Music School of Nursing School of Pharmacy School of Science and Engineering Please select any dietary restrictions we should be made aware of: Please select any dietary restrictions we should be made aware of: Vegetarian Vegan Gluten Free Dairy Free Peanut Allergy Tree Nut Allergy Shell Fish Allergy Other If other, please explain. Please indicate any mobility needs: Is this person a minor (under age 17)* Is this person a minor (under age 17)* Yes No Photo Release A photographer will be present at this event. Please indicate below if we have permission to photograph the registered child and share these images in online photo galleries or to promote future events. Permission to photograph registered child:* Permission to photograph registered child:* Yes, you have permission to take photos of my child(ren)/dependent No, you do not have permission to take photos of my child(ren)/dependent Use of Image Consent and Release I hereby give to Duquesne University of the Holy Spirit (Duquesne), along with its agents, employees, legal representatives, and assigns the right and license to use my child's/dependent's name, image, likeness, and comments in Duquesne materials for internal and external audiences. These materials include, but are not limited to advertisements, brochures, viewbooks, news releases, magazines, newspapers, newsletters, videos, websites, and social media. Participant’s images may be used in all marketing, including university-wide communication for all audiences and across all Duquesne schools and programs. It is hereby stipulated and agreed that such production and use will not violate my child’s/dependent's rights, and I, for myself, my heirs, executors, administrators, and assigns, hereby release and discharge Duquesne and its agents and employees from any and all claims, demands, and/or causes of action of whatever kind, for its actions taken pursuant to the authority granted herein. Further, it is hereby stipulated and agreed that I will receive no compensation for the use of my child's/dependent name, likeness, or comments, and Duquesne University will incur no liability for payment of compensation to me nor any person or organization as a result of its production and use thereof. Name of Parent/Guardian* Parent/Guardian Phone Number* Parent/Guardian Email* I HAVE READ THE ABOVE PHOTO RELEASE AND HOLD HARMLESS AGREEMENT, I UNDERSTAND THE SAME, AND I AGREE TO BE LEGALLY BOUND BY ALL OF THE TERMS STATED THEREIN.* I HAVE READ THE ABOVE PHOTO RELEASE AND HOLD HARMLESS AGREEMENT, I UNDERSTAND THE SAME, AND I AGREE TO BE LEGALLY BOUND BY ALL OF THE TERMS STATED THEREIN.* Yes

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Event Waiver and Release*

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I understand that there are risks to which I may be exposed by participating in this event (the “Activity”). Such risks include physical and emotional injury, illness, potential exposure to viruses and bacteria, hospitalization, and death or damage to me, to property, or to others. I further understand that the University cannot guarantee that participants in the Activity will not contract transmittable diseases. I appreciate the character of the risk taken and voluntarily assume all risk of harm. Therefore, I agree to assume and take on myself all of the risks and responsibilities in any way associated with my participation in the Activity. I release, acquit and forever discharge the University and its employees, agents, members, officers, directors, students and representatives (the “University Releasees” in their official and individual capacities) from any and all liability whatsoever for any and all damages, losses or injuries (including death, mental anguish or emotional distress) to persons and/or property, including but not limited to any claims, demands, actions, causes of action, damages, costs, expenses (including hospital and medical expenses or deductibles) and/or attorney’s fees, that occur during, result from, arise out of or relate to my participation in the Activity. I recognize that this Release means I am giving up, among other things, rights to sue the University Releasees for injuries, damages or losses I may incur. I also understand, and agree, that this Release binds my heirs, executors, administrators, successors, assigns and personal representatives, as well as myself.

I have read this entire waiver and release. I fully understand its terms and provisions, and by clicking submit, I knowingly and voluntarily agree to be bound by it.

I understand that there are risks to which I may be exposed by participating in this event (the “Activity”). Such risks include physical and emotional injury, illness, potential exposure to viruses and bacteria, hospitalization, and death or damage to me, to property, or to others. I further understand that the University cannot guarantee that participants in the Activity will not contract transmittable diseases. I appreciate the character of the risk taken and voluntarily assume all risk of harm. Therefore, I agree to assume and take on myself all of the risks and responsibilities in any way associated with my participation in the Activity. I release, acquit and forever discharge the University and its employees, agents, members, officers, directors, students and representatives (the “University Releasees” in their official and individual capacities) from any and all liability whatsoever for any and all damages, losses or injuries (including death, mental anguish or emotional distress) to persons and/or property, including but not limited to any claims, demands, actions, causes of action, damages, costs, expenses (including hospital and medical expenses or deductibles) and/or attorney’s fees, that occur during, result from, arise out of or relate to my participation in the Activity. I recognize that this Release means I am giving up, among other things, rights to sue the University Releasees for injuries, damages or losses I may incur. I also understand, and agree, that this Release binds my heirs, executors, administrators, successors, assigns and personal representatives, as well as myself.

I have read this entire waiver and release. I fully understand its terms and provisions, and by clicking submit, I knowingly and voluntarily agree to be bound by it.

Yes