Registration Form – Daylong, The Art of Letting Go · 2019-11-19 · Registration Form –...

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Transcript of Registration Form – Daylong, The Art of Letting Go · 2019-11-19 · Registration Form –...

RegistrationForm–Daylong,TheArtofLettingGoWithPeterWilliamsSaturday,December14,2019,8:45am–5:30pmTheMeditationPlace,324MainStreet,Longmont,CO

Pleaseprintandfilloutthisformbeforehandandbringitwithpaymenttotheretreat.Yourcontributionamount(Suggestedis$70):Check Cash ThesuggesteddonationcoversretreatexpensesandsupportsPeter’steaching.Itisaguideline.Givenyourfinances,youmayneedtogivelessorwanttogivemore.Thankyousomuchinadvance!

Name: Phone: Address: Email(ifyoudidnotemailPeterthatyouwerecoming): Emergencycontactnameandphone(s): ParticipantWaiver:IunderstandthatIamwhollyresponsibleformyhealthandsafetyforthedurationoftheretreat,fromitsadventtoclose,andherebyholdharmlessPeterWilliams,whoistheretreatOrganizerandTheMeditationPlace,whoistheOwneroftheretreatvenue,fromanyliabilitywhatsoeverresultingfrommyparticipation.IagreenottoholdtheOrganizerorOwnerresponsibleorliableintheeventofanyaccident,illness(mentalorphysical),lossofpersonalbelongings,physicalinjuryoremotionaldistressresultingfrommyparticipationinthisretreat.IunderstandthatIamfullyresponsibleforobtaininganynecessarymedicaltreatmentshouldanyaccident,illnessordiscomfortariseontheretreat.Signature: Date: