Leadership Summit 2024 Leadership Summit 2024 Lodging/Transportation Preferences & Participant Registration "*" indicates required fields 1Preferences2Agreements3Consents Student InformationName* First Last Name Badge Check here if you want a different name on your badge Preferred Name for Your Badge* First Last PSI City for Name Badge*Select OneBoise, IDCalgary, ABDallas, TXDenver, COEdinburgh, UKFort Wayne, INHonolulu, HIHouston, TXLas Vegas, NVNew York, NYOrange County, CAPhoenix, AZPortland, ORSan Francisco, CASeattle, WAToronto, ONVancouver, BCWashington, DCEmail* Enter Email Confirm Email Mobile Phone*I Want to Receive SMS Updates* Yes, Count me In No, Thank You Gender*Select OneMaleFemaleNon-BinaryTransPreferred Pronouns* He/Him She/Her They/Them Not Listed Preferred Pronouns*Unisex T-Shirt Size*Select a SizeXSSMLXLXXL3XL4XLTravel & AccommodationsLeadership Summit 2024 Student Travel & Accommodations*PSI Seminars will not be providing any transportation to/from Leadership Summit 2024. All students are responsible for arranging their own flights at the Los Cabos International Airport and their own transportation to/from the airport to the Hard Rock Hotel. Students may choose to utilize local transportation or make arrangements directly with the hotel for an additional charge. Everyone must stay on property. All rooms are double occupancy. Students can pick their roommate as long as their roommate is an attendee. Spouses and guests who are not attendees are not permitted. Every student must have a credit card (not debit card) for a $100 per night incidental hold at check-in. Students who wish to extend their stay will have to make arrangements directly with the Hard Rock and tell them that they will be moving into/out of a room block with PSI Seminars. I understandLodging PreferenceWe will make every effort to meet your requests, however, rooms will be assigned in the order in which they are requested. PSI does not guarantee that all requests will be accommodated. Lodging Preference*If you are requesting to share a room with a specific person, that person will also need to list you on their lodging request.Select OneI want to stay with my spouse/relationship (listed below) in a private roomI want to stay with a specific person (listed below) in separate bedsI love meeting new people and will room with anyoneI require special accommodations (disability)Preferred Roommate Name(s)*Special Accommodation Requirements:*Dietary PreferencesDo You Have Special Dietary Needs?* I Eat Everything! Vegetarian Vegan Gluten Free Specify any Food Allergies Leadership Summit 2024 Participant Rules & Recommendations*As a registered participant of Leadership Summit 2024, I agree to the following: Cell phones are welcome in the seminar room and might possibly be used in the class, however, all devices must be on silent to not disturb others. Please wear your name badge in a visable location at all times. Illegal drugs are not to be consumed by course participants during seminar participation. Excessive consumption of alcohol is not recommended. The process, events and other participants' experience and sharing are to be kept by course participants as private and confidential information. Drinks are permitted in the seminar room as long as it is in a spill proof vessel. No alcoholic beverages are permitted in the seminar room. Photography, video or audio recording (in any way whatsoever, including cell phones, tablets or iPads) is strictly prohibited during class sessions. However, we do encourage you to post photos and videos on your social media outside of the classroom. In the event of a medical emergency, contact emergency services. I have read, understand, and agree to the Leadership Summit 2024 Participant Rules & Recommendations GENERAL CERTIFICATION, COVENANT, RELEASE & INDEMNIFICATION AGREEMENT*IN CONSIDERATION of being permitted to enroll in a course of instruction presented by PSI SEMINARS, each of the undersigned, for themselves, their personal representatives, assignees, heirs and next of kin: 1. HEREBY CERTIFIES that they have not had, are not being treated for, and have no knowledge that they presently have any mental, psychological, or psychiatric symptoms or emotional diseases or illnesses, and that they understand that the ADVANCED PSI SEMINARS (“the Seminar”) address and consider personal emotional issues to a greater extent than the PSI Seminar. 2. HEREBY COVENANTS AND AGREES that they will not disclose or divulge, directly or indirectly, to any other person or persons, the content or substance of the Seminar presented by PSI SEMINARS and will not reproduce any of the seminar materials or texts used by PSI SEMINARS. 3. HEREBY PROMISES NOT TO SUE, AND RELEASES AND DISCHARGES PSI SEMINARS, its owners, directors, officers, agents, employees, and independent contractors (the “RELEASEES”) from any and all liability to themselves, their personal representatives, assignees, heirs, and next of kin for all loss or damages, and any claim or demands therefore, on account of physical injury to, or behavior modification or death, the undersigned, whether caused by the negligence of RELEASEES or attending medical personal, or otherwise resulting from or arising out of their participation in the Seminar, participation in the related activities or otherwise. 4. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEES for any loss, liability, damage, or cost they may incur for any intentional or unintentional misuse of the Seminar materials of PSI SEMINARS by the undersigned or others. 5. HEREBY WARRANTS the following statements are true and correct and understands that the RELEASEES have relied upon them in permitting the undersigned to enroll in the Seminar and participate in other activities. (a) None of the RELEASEES has made any oral representations, statements, or inducements to them other than those set forth in this written Agreement. (b) They are eighteen or more years of age. (c) They assume full responsibility for and all risk of bodily injury behavior modification and death whether due to the negligence of the RELEASEES or otherwise. (d) THEY HAVE READ AND VOLUNTARILY SIGN THIS CERTIFICATION, COVENANT, RELEASE, AND INDEMNIFICATION AGREEMENT. 6. Arbitration Clause If a dispute arises out of or relates to this contract, or the breach thereof, and if said dispute cannot be settled through direct discussion, the parties agree at first endeavor to settle the dispute in an amicable manner by mediation administered by the American Arbitration Association under its Commercial Mediation Rules, before resorting to arbitration. Thereafter, any unresolved controversy or claim arising out of or relating to this contract, or breach thereof, shall be settled by arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration Rules, and judgment upon the reward rendered by the arbitrator'(s) may be entered in any court having jurisdiction thereof. I have read, understand, and agree to the General Certification, Covenant, Release & Indemnification AgreementMedia Consent and Authorization*I hereby consent to and authorize PSI Seminars, LLC (hereafter “PSI Seminars”), its affiliates, agents, representatives and all persons or corporations acting with its permission or upon its authority (collectively the “Producer”), to use my name, voice, photograph, video image and likeness, together with my quotes, letters, endorsements and testimonials, whether written or oral, in whole or in part (described as the “Communication”), in connection with the exhibition, merchandising, advertising, endorsement, promotion, distribution, sale and any other activities (the “Program”) relating to the marketing and sale of training programs, intellectual properties, or software (the “Product”) referred to in my Communication. This right shall include the right to Incorporate and use the Communication in any video, audio, photograph, catalog, packaging, and package inserts and all other media, and to reproduce, exhibit, broadcast, transmit and distribute advertising containing the Communication relating to the Product. I hereby assign and agree to assign in perpetuity to PSI Seminars any and all worldwide rights, including the copyrights and renewals thereof, in, and to the advertising and the uses to which it may be applied. I agree to execute in the future any further documents that may be necessary to perfect PSI Seminars’ ownership rights in any advertising or other works containing the Communication. I certify that I am a bona fide user of the Product. I certify that my endorsement of, or testimonial about, the Product in the Communication is true and accurate and reflects my honest beliefs and real experiences in the quality and benefits of the Product that can be experienced by an average consumer. If at any time, I believe that my endorsement or testimonial as contained in the Communication is no longer true, accurate, and reflective of my experience with the Product, I will promptly notify the Producer at the address below. I am providing the Communication and my endorsement or testimonial of my own free will, and I have not been paid or compensated in any way for giving my endorsement or testimonial. I acknowledge that the Producer has relied on my statements in producing the Program and selling the Product. I waive any and all rights to inspect or approve the Communication, advertising, or the uses to which it may be applied as provided for herein. I have read, understand, and agree to the Media Consent and AuthorizationThis field is hidden when viewing the formDeclining Media Consent and Authorization*I understand that there will be frequent filming, photography, and recording at Momentum 2022 and that portions of the event will be livestreamed. By declining the Media Consent and Authorization, I will take on the responsibility of remaining away from recording devices and will not participate in any activities which have the sole purpose of media use (scavenger hunt, testimonials, etc) unless I sign a media release. I decline the Media Consent and AuthorizationAssumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19*The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. PSI WORLD, AND PSI SEMINARS, LLC strongly recommends vaccination prior to attending any seminars and/or indoor gathering. PSI WORLD, AND PSI SEMINARS, LLC has put in place preventative measures to reduce the spread of COVID-19; however, PSI World and PSI Seminars cannot guarantee that you will not become infected with COVID-19. Further, attending our seminar could increase your risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending a PSI Seminar’s event and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the seminar may result from the actions, omissions, or negligence of myself and others, including, but not limited to, PSI employees or staff, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at, or participation in PSI Seminars (‘Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless PSI, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of PSI World or PSI Seminars, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any PSI Seminars program. I have read, understand, and agree to the Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 Δ Leadership Summit 2024 September 15th – 22nd, 2024 Hard Rock Hotel Cabo San Lucas, Mexico