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December 8, 2021
YTAC Winter 2021 In-Person Participation Survey
YTAC Winter 2021 In-Person Participation Survey
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Discord Name
(Required)
In-Person Attendance Checklist
I am local to Charlotte and able to be in the specified location by 4:30pm EST on the days that I've indicated I will be in attendance.
I will be able to have someone pick me up from the specified location by 6:30pm EST.
I will be able to coordinate my own transportation for both pickup and drop off.
I am willing to wear a facemask while in attendance to protect myself and others from the potential spread of COVID-19.
I have not tested positive for COVID-19 in the last 14 days leading up to the event, and I am not experiencing symptoms of COVID-19 such as a cough, fever or chills, shortness of breath or difficulty breathing, fatigue, muscle or body aches, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea.
I am vaccinated for COVID-19 OR I have received a negative COVID-19 test in the three days leading up to the event.
Photo and Media Consent and Release Form
(Required)
Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Carolina Fintech Hub, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to: (a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice; (b) Permission to use my name; and (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness. This consent is given in perpetuity and does not require prior approval by me.
No
Yes
SELECT ALL THAT APPLY -- Availability for the Hornets Arena (Uptown)
Wednesday, Dec 15
Thursday, Dec 16
SELECT ALL THAT APPLY -- Availability for the SPIN Office (3401 Saint Vardell Lane - Suite A Charlotte, NC 28217)
Thursday, Dec 9
Friday, Dec 10
Wednesday, Dec 15
Thursday, Dec 16
Friday, Dec 17
Posted by Pasha Maher
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