2nd Annual Christmas Angels Toy Drive
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Memorial Wall Page 2
Families of Murdered Victims - San Antonio
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Gofundme account creation authorization
By completing the form below I acknowledge and swear that I am a authorized family member who has permission to make decisions on behalf of my deceased family member. I hereby give permission to Families of Murdered Victims - San Antonio to create, manage and collect funds on behalf of my family for the cause described below via a Gofundme account. Once the campaign is complete I understand that unless otherwise agreed upon, Families of Murdered Victims will accompany me to the merchant to complete payment utilizing the collected campaign funds for which the campaign was for. I understand that Families of Murdered Victims and I have agreed upon a goal amount and that Families of Murdered Victims has in no way promised or guaranteed me that the goal will be reached or that I am guaranteed the goal amount if it not collected in full by the Gofundme Campaign.
I hereby give Families of Murdered Victims- San Antonio the authorization to advertise, promote and distribute the Gofund me Campaign on my behalf to help raise funds and promote the cause.
BY COMPLETING THE FORM BELOW, I HEREBY RELEASE, WAIVE AND CONVENANT NOT TO SUE AND FURTHER AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE FOLLOWING PARTIES: FAMILIES OF MURDERED VICTIMS - SAN ANTONIO.
I AGREE THAT IF, DESPITE THIS AGREEMENT, I, OR ANYONE ON MY BEHALF MAKES A CLAIM FOR LIABILITY AGAINST ANY OF THE RELEASED PARTIES, I WILL INDEMNIFY, DEFEND AND HOLD HARMLESS EACH OF THE RELEASED PARTIES FROM ANY SUCH LIABILITY WHICH MAY BE INCURRED AS A RESULT OF ANY SUCH CLAIM. THIS AGREEMENT EXTENDS TO ALL ACTS OF NEGLIGENCE BY THE RELEASED PARTIES AND IS INTENDED TO BE AS BROAD AND INCLUSIVE AS IS PERMITTED BY THE LAWS OF THE STATE OF MAINE. THIS AGREEMENT IS INTENDED TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY OF THE RELEASED PARTIES TO THE GREATEST EXTENT ALLOWED BY LAW
Authorized Family Member
Please provide your DOB
Deceased Family Member
Date of Birth of deceased
Date of Death of Deceased
Gofund me Campaign Cause
Please tell us for what campaign cause is the gofund me to be used for. What will the funds be collected for.
Gofund Goal Amount
Please input the amount that was agreed upon between yourself and FMVSA.
Merchant in which funds will be paid to.
Please describe the merchant to whom the funds will be paid to once the campaign has been completed.
BY SIGNING BELOW, YOU CERTIFY THAT YOU HAVE READ THIS AGREEMENT, THAT YOU KNOW AND UNDERSTAND THE MEANING AND INTENT OF THIS AGREEMENT AND THAT YOU ARE ENTERING THIS AGREEMENT KNOWINGLY AND VOLUNTARILY.
Please electronically sign your name
Electronic Signature Pin
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