Connectivate 1/26/13 Payment and Agreement Form
This form will help me sort out all of your payments, and not have to charge you an extra $2.50 to use a ticketing service. This is my way of getting across important info. Please fill it out carefully and entirely.
What is your name? *
I am paying by: *
What is the name of the paypal account that is paying for your ticket? *
Is this paypal account paying for more than one ticket? If so how many? *
If you are paying for more than one person, please list their names below.
Please select which option you are paying for *
Please put the amount that you paid via paypal. $15-20 tickets= $1 fee. $30-$40 tickets =$1.50 fee *
Release of Liability. *
You agree to release Jamie Luv and all instructors and partners from liability for your participation in this event. This event includes the possibility of participating in workshops and experiences that require your full presence and attention, and could result in injury. You are responsible for determining that you are capable of participating and do so at your own risk. Additionally, you will be offered beverages with unique legal and safe ingredients. Make sure that you understand the ingredients and that they are SAFE FOR YOUR BODY. If you take prescription drugs, are pregnant or have any medical condition, consider it carefully and ask if you are concerned.
This is not a sexual event. Please keep things cozy and comfortable for everyone *
Awesome Workshop Tickets get to choose 3 of the 4 options. First come, first serve. Please indicate which 3 you would prefer.
We will be serving a selection of delectable delights. So we can best feed you please tell me which fits you best. All options will be wheat free and as organic, local and sustainably grown as possible!. *
BYOB and CUP! This event is intended to be as classy and Eco friendly as possible. We will provide you with delicious drinks, we ask you to bring your own cup. If you would like to bring your own alcohol we ask that you "check it" at our Check Bar. There is a one time charge of $5. You can access your beverages as many times as you want for that fee. We will keep your drinks labeled on ice, and our servers will serve you all night! Win/win. Please bring your own cup! Cups will be sold for $5 at the event. Please drink responsibly, and have a designated driver. *
If you are paying for someone else, please have them read this agreement also. You are responsible for making sure that they are well prepared!
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