CosFest Participant Waiver Form

- Please print this important form from your computer and submit it to the CosFest Office when you check in.
- All minors (17 and below) must fill out a Minor Permission form.
- For group entries, each member of your group must turn in a copy of this form.


Participant's Name: ___________________________________________________________


Group Name: ___________________________________________________________________


Date of birth: __________________________________   Age: _________________________


Phone Number: _________________________________________________________________


Address: 

_______________________________________________________________ 

_______________________________________________________________ 

_______________________________________________________________

_______________________________________________________________


I, ___________________________________________ (please print),  will participate in the
 Pacific Media Expo 2009 CosFest events taking place November 6 - 8th, 2009. I further 
give my consent to Pacific Media Expo to acquire emergency medical treatment from 
competent medical personnel/facilities should that become necessary for any reason. 
I also grant Pacific Media Association the right to use my name, likeness and/or footage 
taken for promotional purposes. My signature below indicates that I understand that I must 
abide by all rules, regulations and staff instructions while participating in the contest, and that 
PMX staff cannot prevent injuries because they cannot always control the conditions present 
or be present at all times. My signature below constitutes and is evidence of my agreement to 
(1) accept general liability for the participation of myself in CosFest and (2) indemnify and hold 
harmless Pacific Media Expo, Pacific Media Association (PMA), its employees and agents, either 
jointly or severally, from and against any and all claims, damages, causes of action or injuries, 
including reasonable attorneys’ fees and costs expended in defense thereof, incurred or 
resulting from my participation in CosFest.


Signature ____________________________________________________________

Date ______________________________________________