I have registered as a participant and/or parent or legal guardian of a participant in The Guthy-Jackson Charitable Foundation 2024 NMO Roundtable Conference (the "Program"). I am over the age of 18 years old. I understand and acknowledge that my execution of this General Waiver and Release of Liability is a precondition of my participation in the Program. With respect to my participation in the Program, I acknowledge and agree as follows:

1. I wish to participate in the Program to engage in a dialogue with leading NMO clinicians and researchers in order to learn more about Neuromyelitis Optica Spectrum Disorder (NMO / NMOSD). My participation in the Program is voluntary. I understand that the information disseminated at the Program is being offered solely as public health information and is not intended to constitute medical or clinical advice to me or any particular individual. Travel undertaken in connection with attending the Program, and/or participation in the Program, may place unusual physical and emotional demands on me or on a person in my care.

2. I am fully aware that by participating in the Program, or by traveling in order to participate in the Program, I risk being exposed to illness. I acknowledge that I am choosing to participate in the Program (including traveling to the Program), either personally or with a person in my care. I acknowledge my assumption of the risk of becoming infected and will not hold The Guthy-Jackson Charitable Foundation responsible should I test positive for COVID-19 or any other illness while at or after attending the Program.

3. I agree that I will not hold The Guthy-Jackson Charitable Foundation responsible or liable in any manner for any Harm (as defined below) which I or a person in my care may sustain as a result of my participation in the Program (including travel to and from the Program), whether such Harm is or may be attributable to the negligence, gross negligence, intentional or other acts or omissions of any person(s). For purposes of this General Waiver and Release of Liability:

a. All references to The Guthy-Jackson Charitable Foundation shall include the trustees, officers, directors, principals, employees, attorneys and other agents of The Guthy-Jackson Charitable Foundation.

b. "Harm" means any injury, sickness (including that associated with becoming infected with COVID-19), Flu or other illness, damage, ill-effects or harm of any kind which I may suffer, however serious (including death), and including without limitation any related health care expenses and legal and other fees and costs, whether incidental or consequential.

4. I hereby release, waive, discharge and relinquish any action or causes of action which I may have, now or in the future, against The Guthy-Jackson Charitable Foundation based on any Harm which I may suffer as a result of traveling to or participating in the Program. I further release, waive, discharge and relinquish any action or causes of action which my heirs or estate may have, now or in the future, against The Guthy-Jackson Charitable Foundation based on any Harm which I may suffer as a result of traveling to or participating in the Program.

5. Under no circumstances shall I or my heirs, executors, administrators or assigns prosecute or present any claim for personal injury, property damage or otherwise against The Guthy-Jackson Charitable Foundation for any causes of action described in Paragraph 4, or based on any Harm that I may suffer as a result of my participation in the Program (including travel to and from the Program).

6. I understand that this General Waiver and Release of Liability is an important legal document and that it could have a significant effect on my legal rights. I have consulted with an attorney (or have had an opportunity to consult with an attorney but have chosen not to do so) regarding the implications of signing this General Waiver and Release of Liability before signing it. Neither The Guthy-Jackson Charitable Foundation nor its legal advisors have offered legal advice to me with respect to this General Waiver and Release of Liability.

7. I have read the foregoing paragraphs of this General Waiver and Release of Liability, understand the risks I may face as a result of travel to and from and participation in the Program, and voluntarily sign this General Waiver and Release of Liability with full knowledge of the legal consequences of doing so.

8. In consideration of my participation in the Program, I exempt and release The Guthy-Jackson Charitable Foundation from liability for any Harm which I may suffer in connection with travel to or from, or participation in, the Program, as set forth above.

**PARENT MUST ACCEPT TERMS IF THE GENERAL WAIVER AND RELEASE OF LIABILITY IS FOR A MINOR**

I am a parent (or guardian) of the minor who has agreed to this General Waiver and Release of Liability. As such minor's legal guardian, I hereby confirm and agree on behalf of the minor and on behalf of such minor's legal guardians, representatives, and any other persons who may make, assert or otherwise derive any claims or rights through such minor, to be bound by all the provisions contained in this General Waiver and Release of Liability.
 
FOR TRAVEL GRANT APPLICANTS ONLY
You will be contacted to discuss your needs for a travel grant at a later date. NMO Patient Day Travel Grants are available for people diagnosed with NMO/NMOSD who require financial assistance to attend. A Statement of Financial Need is required upon application. Travel Grants are very limited for this event. Travel Grant attendees receive 50% discount admission price ($25) and a one time credit of up to $500 towards either the hotel or airfare. Travel Grants are reviewed and subsequently granted on a first-come, first-served basis, and prioritized by those who have never before attended the foundation's NMO Patient Day in Los Angeles, CA. While supply lasts. If Travel Grant capacity has reached its maximum, a Travel Grant Wait List will be activated. All applicants will be contacted by a member of the GJCF team to review needs and set up the travel grant if approved.

The foundation does not sell or share your information with anyone. We collect information like your name, email address, mailing address, phone number and guests so we can provide the services described in this form and future email notifications.