If applying through the ASLFL website, you must send a signed consent form to firstname.lastname@example.org.
Photograph and Film Footage Release Statement:
I give my consent to the ICCUSA Foundation to publish and use photographs and film footage taken of my son/daughter (as named above) at the Albert Schweitzer’s Leadership for Life Conference. All materials become the property of ASLFL and may be used, without further permission, for publicity purposes including print, television or web based sources. If you have any queries in relation to the above condition, please contact ASLFL at: to discuss the matter.
Notes on completing the form:
- Please ensure that you complete all sections of the form carefully.
- Please ensure you include your full address as we will be sending you further information by email.
- Please include a contact number as we may need to contact you directly about your application.
- Selection is based on the information you provide on the form, so take the time to think about your answers.
- Late applications will not be accepted so submit early to avoid disappointment.
Ensure that your parent/guardian sign the form. Applications will be returned if they are not signed.
Albert Schweitzer Leadership for Life
219 South Street – Suite 203
New Providence, New Jersey 07974