• By sending this electronically, I acknowledge that I have completely read this application and comprehend it fully.

    I certify that the above information is correct, and I understand that the information will be verified.

    I understand that by submitting this form electronically, I agree to release and covenant to hold harmless My Path, ICCC, and it's members from any claims, damages, costs, or actions incurred because of my participation in My Path Community Champions.

    I agree that if I'm unable to participate in My Path Community Champions anymore that I will notify My Path and ICCC to let them know.

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