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