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Register as a Team Leader
 

Please fill out the form below to become a team leader. After registering, your company can sign up for Volunteer Week Projects.

* = Required fields
 
STEP 1: Team Leader Information:
Company Name*:
Team Leader First Name*:
Last Name*:
Title & Department*:
Email Address*:
Phone*:
Fax:
Address*:
City*:
State*:
Zip*:
Region*:
   
Alternate Contact First Name:
Alternate Contact Last Name:
Alternate's Email:
  
Company Chief Executive:
  
Password Information:
Enter Password*:
Re-Enter Password*:
 
Questionaire:
 
Has your company/office participated in Volunteer Week previously?
YesNo
If so, what year did you last participate?
 
Will multiple office locations of your company participate in Volunteer Week this year?
YesNo
If so, please indicate if individual Team Leaders (TL) will be assigned to each office.
Yes, each office will have its own T.L.No, I will coordinate all office volunteers
NOTE: It is advisable that separate team leaders be assigned for each location/office. Please complete a separate registration for each team leader.
 
Do you have any recommendations on local charities that we should consider inviting to participate?
YesNo
Please list your recommendations. Include contact information wherever possible:
 
Photo Release:

I/We hereby irrevocably grant to the Insurance Industry Charitable Foundation (IICF) and its licensees, successors and assigns, the right, license and privilege to use my/our name, likeness, voice, performance, personal characteristics photograph and biography, in whole or in part, throughout the universe, in all formats and media now known or hereafter devised, in such manner as IICF shall deem appropriate for the purpose of promoting, advertising and publicizing IICF and its charitable activities.

I/WE hereby release and agree to indemnify IICF and its licensees, affiliates, successors and assigns, from and against any and all liability, costs and expenses, including reasonable attorneys’ fees, arising out of the exercise of the rights granted hereby. In no event shall I/we have any right to seek or obtain injunctive or other equitable relief with respect to IICF. The parties submit any disputes arising out of or related to this Publicity Consent and Release cannot be terminated, rescinded or amended hereafter except by a written agreement, signed by all parties. This Publicity Consent and Release shall be exclusively governed by and construed in accordance with the laws of the State of California, without regard to conflicts of laws principles.
Do you agree to these terms?:
YesNo