Moment of Death Training Weekend
Copy & print this form
Please register prior to March 15th to
Ensure your Enrollment as Space is Limited
City, State ________________________________________________
I have read and understood the Cancellation Policy and the Disclaimer of Responsibility below.
Enclosed is my check for $275 payable to Patricia Shelton
Please mail care of: Melissa Lewis, RN BSN
46 Churchill Rd
Wethersfield, CT 06109
Cancellation of Registration: There will be no refunds for cancellations made by registrants. We reserve the right to cancel training on 14 days notice due to low attendance.
Disclaimer of Responsibility: By registering for this program the seminar member specifically waives any and all claims of action against Patricia Shelton, Melissa Lewis, & 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. organization or employee providing services included in this seminar