Body-Mind Workshop Registration Form

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Name

_________________________________________________

Address

_________________________________________________

City, State, Zip

_________________________________________________

Telephone/Email

_________________________________________________

I have read and understood the Cancellation Policy and the Disclaimer of Responsibility below.

Signature _______________________________________

Enclosed is my check for $75 payable to Patricia Shelton.

Please mail checks:

C/O Melissa Lewis, RN BSN

46 Churchill Rd

Wethersfield, CT 06109

 

Cancellation Policy: As Ms. Shelton will be traveling from a distance there will be no refunds on registration, unless due to cancellation.

Disclaimer of Responsibility: By registering for this program the seminar member specifically waives any and all claims of action against Patricia Shelton and staff for damages, loss, injury, accident, or death due to negligence on the part of any organization or employee providing services included in this seminar.