Beaver Medical Group Mindfulness May Challenge
Please complete form by April 30th
Last Name
First Name *
Email *
Address *
Phone number
Release
In consideration of participating in Mindfulness May, I, intending to be legally bound, do hereby for myself, my heirs, executors and administrators, waive, RELEASE and discharge any and all rights and claims for damages which I may have, or which may hereafter occur to me against the Mindfulness May committee, planners, organizers, volunteers, Beaver Medical Group, L.P., EPIC Management Inc., sponsors, contributors, the persons, or organizations affiliated, their representatives, successors and assigns for any and all injuries suffered by me due to my involvement in the EMPOWER program. I will additionally permit free use of my name and pictures in broadcasts, television, radio, print, Internet, and any other form of media promotion. I attest and verify that I am physically fit to participate in the Mindfulness May program, and I have my doctor’s approval to exercise, if such approval is needed.
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