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European
and Eur-Asian
Shamanism Registration
Cost of the workshop is
$75.00. Due to space limitations, pre registration is required!
Deadline for pre registration is July 15. Please make
checks payable
to "Church of Earth Healing"
Name:____________________________________________________________
Street
Address:____________________________________________________________
City:_____________________________________
State:__________
Zip:_____________
Phone # (optional)
_______________________________
E Mail Address (optional)
__________________________________
Would you like to be added to
Pagan.com's email list to be notified of future events? Yes
_____
No _____
Please Read the
following
carefully
before Signing!
The
European
and Eur-Asian
Shamanism workshop weekend
is an outdoor camping Event in a woodland setting. The site is
primitive
with MANY stumps and obstacles. As with any outdoor activity,
there
are numerous potential hazards and dangers to people AND
property.
No assurances of safety can be made!! I understand that certain
Event
activities may be physically strenuous and I will not participate
in them
unless I am medically able to do so. By attending, I agree that I am
responsible
for my own actions and welfare. I assume all risks associated with
attending
this Event, including, but not limited to falls, the effects of the
elements,
weather, waterways, fire, etc., any workshops or rituals, equipment
failure
or misuse, damage to property, contact with vegetation, insects,
wildlife,
pets, and other participants, sudden Yak stampedes, and assorted
"stupid
people tricks"; all such risks being known and appreciated by me.
Having
read this waiver, and the rules listed on the reverse side, and knowing
these facts and being in total agreement with them, and in
consideration
of your accepting my application, I, for myself and anyone entitled to
act on my behalf, waive and release the Church of Earth Healing, , Out
of the Dark inc., Blackwater Campground and all sponsors,
their
officers, representatives and successors from all claims and
liabilities
of any kind arising out of my participation in the European
and Eur-Asian
Shamanism workshop weekend.
Signature ______________________________Date:___________________
Parent's Signature if
Under 18
years
__________________________________Date:____________
Send to:

European
and Eur-Asian Shamanism Workshop
c/o
Out of the Dark, Inc.
7651 Whispering Pines
Trail
Windsor, VA
23487
(757) 357-0664

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