NAME:
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ADDRESS: (include city, state and zip code)
EMAIL
ADDRESS:
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DID YOU HEAR ABOUT THIS COURSE?
LIABILITY RELEASE FORM
Date_____________________________
I will not hold Beth Beurkens, Peter Salomone, Linda Burquez and the Core Movement Center, or The Foundation for Shamanic Studies legally responsible for any injury, illness, accident or other misfortune that may occur in connection with my participation in the Way of the Shaman workshop at Core Movement Center, Nevada City, CA on April 10 and 11, 2010.
Signature____________________________________________________________
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(PLEASE SEND VIA US MAIL. DO NOT EMAIL)
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Secure
your registration by putting your deposit or full tuition check
(made out to Beth Beurkens) in an envelope addressed to:
Beth
Beurkens, P.O. 483, Ashland, OR 97520
Thank
you for your registration. We look forward to sharing the Way of the Shaman with you. |