Name *

First Name

Last Name

Personal Cell Phone Number *

Country

(###)

###

####

Agent's Name

First Name

Last Name

Position *

Point Guard

Shooting Guard

Combo Guard

Small Forward

Center

Checkbox 1 *

WAIVER OF LIABILITY RELEASE FORM I am aware of the nature of this activity and I hereby assume responsibility listed in this waiver form to participate and to be photographed or video for publicity and marketing purposes. I will not hold the IEBX and/or its employees legally responsible for any damages or negative action in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of IEBX prior to participation in this program. By checking the below box you agree to the terms listed in the above waiver form. This is the equivalent to your signature. Yes, I Agree to the terms in the IEBX wavier form

Agree to IEBEX Liability Waiver