SEEDS LEADERSHIP™ PROGRAM - SEPTEMBER (14 - 16) 2018 - TORONTO, CANADA
FOR PAYMENT & MORE INFORMATION ABOUT SEEDS LEADERSHIP™ PROGRAM, PLEASE VISIT:
http://seedsleadership.com/services-item/the-seeds-leadership-program-toronto-september/


SEEDS Leadership™ is a program designed by RAIN & Origin of Wisdom™.

Email address *
Participant Information
Please fill out this form completely and return it within one week of receipt. ● The accuracy and completeness of your answers are important as a condition to your participation in this program. ● We will hold the information on this form in confidence. ● Please answer every question and sign your name in the appropriate place.

First Name *
Your answer
Last Name *
Your answer
Name I Would Like To Be Called (On Name Tag) *
Your answer
Home Address *
Your answer
City, Province/State, Zip Code *
Your answer
Phone Number *
Your answer
Date of Birth *
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DD
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Note: If you are under 18 years of age, you must have the consent of your parents or legal guardian in order to participate in this program. See the end of this form.
My Profession *
Your answer
What Do I Intend To Accomplish From This Program? *
Your answer
Name Of The Person Who Introduced Me To This Program (Use Enter To Create Multiple Entries) *
Your answer
Please List The Names Of All Family Members, Relatives, Friends and Business Associates Who Are Participating In This Program With You. (Use Enter To Create Multiple Entries) *
Your answer
Confidential Health Condition Questionnaire
Are you under the care of a physician or a psychiatrist?
If Yes, Please Describe.
Your answer
Are you receiving medication?
If Yes, Please Describe.
Your answer
Have you had a history of heart trouble, rheumatic fever, diabetes, asthma, kidney or liver involvement, epilepsy, bleeding, disorder, or brain injury?
If Yes, Please Describe.
Your answer
Are you allergic to any food or medicine?
If Yes, Please Describe.
Your answer
Have you had surgery with in the last year?
If Yes, Please Describe.
Your answer
Have you had any serious illness or surgeries not listed that we should know about?
If Yes, Please Describe.
Your answer
Is there any reason or physical condition why you could not participate in any physical exercise or late evening session?
If Yes, Please Describe.
Your answer
Has anyone in your family ever attempted or committed suicide?
If Yes, Please Describe.
Your answer
Emergency Contact
Name *
Your answer
Address *
Your answer
Phone *
Your answer
Relationship *
Your answer
With my registration in Dr. Annie Lim International Inc. & Origin of Wisdom - “Seeds Leadership™” program, I agree to the following terms and conditions:
Consent Agreement:

I am advised that Seeds Leadership™ program is an educational seminar and not therapy, and accordingly, I have no expectations along these lines.

I am also advised that Seeds Leadership™ program may include long hours and may be physically and emotionally demanding.

I acknowledge that I have evaluated the advisability of taking the training in terms of all the history and circumstances of my life and I accordingly, agree to take full responsibility for the mental, emotional and spiritual well being I attain, as a result of the training.

I am fully aware that Seeds Leadership™ program may bring up incidents from my past, which may be emotional for me.

I acknowledge and declare that I am voluntarily participating in the Seeds Leadership™ program.

I hereby release Dr. Annie Lim International Inc. its founders, trainers, employees, any and all other Seeds Leadership™ program participants and the premises in which Seeds Leadership™ program is held, from any and all liability as a result of any physical, mental or emotional injuries, or damage to personal property suffered by me either during or as a result of my participation in Seeds Leadership™ program.

I also acknowledge that I am in good physical and mental health and condition and have no ailment, disability or impairment, which (might) prevent me from participating in Dr. Annie Lim International Inc. nor which might be aggravated or activated by taking Seeds Leadership™ program.

If I am in therapy, I warrant and represent that I have discussed the training with my therapist, and have ascertained from him/her that my participation is not likely to aggravate or activate any symptoms, illness or disorders which I may have, nor would it be harmful to my health or well being to participate in Dr. Annie Lim International Inc. Seeds Leadership™ program.

Confidentiality: It is my understanding that Dr. Annie Lim International Inc. is an experience, private and personal to each participant, and I accordingly agree to respect the confidentiality of all the participants and to keep all material shared or discussed by them, private and confidential.

Payment and Refund Policy: It is my understanding that the program payment is due in full by registration unless otherwise negotiated in writing. If I am paying with a payment plan, I understand that I do not receive any discounts for tuition and I must pay the total price.

Cancellation Policy: In the event, I am not able to attend the program for which I have registered, I must notify the promoters in writing at least seven days before the program starts. Provided I notify them before the seven day period, I will have the option to attend the next Seeds Leadership™ or apply my payments to another program under The Seeds Leadership™ umbrella, or substitute myself with another person not already registered. Please note: All payments are transferrable only and are not refundable. These options are available to participants who have placed their deposits or paid in full.

Release: I understand that the Seeds Leadership™ program may or may not videotape the program. I consent to and authorize Seeds Leadership™ to use my name, voice, appearance, image, words and participation in whole or part in these recordings without compensation to me and that they may be used for educational and promotional applications.

By signing (or digitally signing) this document, I acknowledge that I have read and understand all of the above terms. I freely and voluntarily agree to abide by all of these conditions. Please send back (email, mail or by hand during registration) to Dr. Annie Lim International Inc. or program organizer.

Is There Anything Else You Would Like To Communicate For Now? *
Your answer
Check & Agree *
Required
Under 18 Years Of Age* (Skip This Portion If You Are of Legal Age)
If you are under 18 years of age, your parent or legal guardian must read the following:

ALL PARENTS OR LEGAL GUARDIANS WHO SHARE LEGAL CUSTODY OF THE ABOVE-NAMED MINOR MUST CHECK BELOW IN ORDER FOR THE ABOVE-NAMED MINOR TO PARTICIPATE IN THE OOW FORUM.

AS PARENTS OR LEGAL GUARDIANS OF THE ABOVE-NAMED MINOR:

1. WE/I HAVE GIVEN OUR/MY PERMISSION FOR THE ABOVE-NAMED MINOR TO TAKE THE OOW COMMUNICATION CURRICULUM.

2. WE/I AGREE TO COMPLY WITH THE ABOVE NOTICE OF IMPORTANT INFORMATION AND HEALTH WARNINGS, CONFIDENTIALITY AGREEMENT, PROPRIETARY MATERIALS AGREEMENT AND INFORMED CONSENT ON HIS/HER BEHALF.

3. WE/I AGREE THAT OUR/MY SIGNATURE(S) ON A FAXED COPY OF THIS DOCUMENT SHALL BE DEEMED AN ORIGINAL.

4. ORIGIN OF WISDOM WILL SEND AN EMAIL AND CALL YOU FOR VERIFICATION.

Name Of Parent / Legal Guardian
Your answer
Email & Cell Phone Number of Parent / Legal Guardian
Your answer
A copy of your responses will be emailed to the address you provided.
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