Your Creative Power Retreat REGISTRATION Form
Please submit one form for each person you are registering. Your registration is complete after we receive your deposit by one of the methods listed below. Thank you!
/// For a complete retreat description and facilitator bios, visit www.tummdance.org/events ///
First Name *
Your answer
Last Name *
Your answer
Your Email *
Where you will receive additional retreat information.
Your answer
Mobile Number *
Where we can send last minute announcements in case of a change.
Your answer
Emergency Contact Person *
Your answer
Emergency Contact Mobile Number *
Your answer
How do you plan to pay for the retreat? *
A deposit of $25 is required to hold your spot. Full Payment ($65) must be received by July 17.
WAIVER OF LIABILITY I understand and agree that in participating in any movement class or workshop there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me during classes and workshops. I also exempt, release, and indemnify Ocean's Echo Reiki & Wellness and Tulsa Modern Movement (TuMM), its owners, agents, venue facility owners, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, or property which may arise out of or in connection with participation in any classes or activities conducted by Ocean's Echo Reiki & Wellness and TuMM. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Ocean's Echo Reiki & Wellness or TuMM, its owners, agents, venue facility owners, volunteers, assistants, employees, guest artists, faculty members, and/or students liable for such damage, loss, injury, or death. *
Please type your full name below to sign that you understand and agree to the waiver. *If you are registering another person, please type "for another" and we'll give them the Waiver in person. Thank you.
Your answer
AUTHORIZATION TO USE PHOTOGRAPHS AND/OR AUDIO-VISUAL I hereby authorize Ocean's Echo Reiki & Wellness and TuMM, its employees and volunteers to use, reproduce, and/or publish photographs and/or video that may pertain to me—including images, likeness and/or voice without compensation. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. *
Please type your full name below to sign that you understand and agree to the authorization. *If you are registering another person, please type "for another" and we'll give them the authorization in person. Thank you.
Your answer
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