2010 SMP Regional Meetings

Select your SMP State:

Registration Type

SMP sub-contractors/sub-grantees are considered SMP
First Name:
Last Name:
Organization:
Job Title:

Email:
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Phone: ex
Fax:

Address:
Address 2:
City:
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Zip:

Special Needs:
Please indicate if you will require special aids, services and/or accommodations ( e.g., wheelchair access).

AoA may photograph, audiotape, videotape, interview, and create transcripts of various people and events of interest to its stakeholders. AoA seek permission for capture and use of major participants' likenesses and words as the following text suggests. I assign and grant to AoA the unlimited right and permission to capture, use, copyright, reproduce, and publish any photographs, film, video tapes, electronic representations, sound recordings, and written and/or drawn documents that contain my likeness, my contributed comments, or work conducted with AoA. I agree to relinquish all rights, title, and interest I may have in the finished product or connected products that may be used in connection to it.

I agree

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