Name *

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

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Liability Release *

I release the Land Trust for the Mississippi Coastal Plain ("LTMCP") and any of its agents or employees from any and all liability growing out of any injuries or damages resulting from my volunteer work with the Land Trust for the Mississippi Coastal Plain. I understand that by checking the "I agree" box below, I am releasing any and all claims against LTMCP.

I agree

Date *

MM

DD

YYYY