First Name/Nickname*

Email*

Your name and email address is a digital way of signing the FOIP and Likeness Release Agreement. This is mandatory, however, your information will not be used, shared externally nor spammed after signing.

FOIP and Likeness Release Agreement *

By participating in this event or activity, I acknowledge and consent to the collection, use and disclosure of my personal information, including photographs, audio or video recordings, in accordance with the Alberta Freedom of Information and Protection of Privacy Act (FOIP).

I understand that this material may be used for informational, promotional or educational purposes by the Alberta Prosperity Project, and may appear in print, online or other public formats.

I waive any right to inspect or approve the finished product or its use, and I confirm that I will not receive any compensation, reimbursement or royalties for the use of my image, likeness or recorded statements.

Yes, I agree

No, I do NOT agree (clear form)

Are you retired?*

Yes

No

Occupation/Job/Role in Life*

Strong and Free Albertan ____ How many years?*

The values I believe in are:*

My work ethic is:*

What/Who is motivating you to stand for Alberta Independence?*

My hope for Alberta’s future is:*

I SUPPORT A SOVEREIGN ALBERTA! *

Yes

No

Still figuring it out