application form shiatsupractor

All persons attending the 15th International Shiatsu Conference participate on a purely volunteer basis. As a volunteer, each participant shall assume all risk and potentially related liability in relation to their involvement in the Conference.
I, the undersigned, hereby release and forever discharge the Japan Shiatsu College and the Canadian College of Shiatsu therapy and any of its employees, officers and agents from any liability, now or in the future, arising out of accident, illness, injury, of death, in any way connected with damages relating to any acts of omission of errors of a Shiatsu practitioner or student under their direction.
I authorize Japan Shiatsu College and the Canadian College of Shiatsu Therapy to take necessary action in case of emergency. I accept responsibility for disclosing any existing medical problems to the practitioner and to ascertain, from a medical doctor, if there is any reason why I should not receive Shiatsu treatments.

15th International Shiatsu Conference Application Form (Shiatsupractor) Please check "□", the categories which apply to you:
□ Shiatsu Seminar & Workshop only		$180.00 ※
□ T-shirt (additional Order) ＠25.00 ×		$
Total		$
※Shiatsu Seminar & Workshop fee includes lunch and the commemoration T-shirt. Participant Information (Applicants must have taken Shiatsu Foundation, Physiology and Anatomy)
Name	Tel
Address
E mail	Occupation
Payment Attendance Fee is not refundable. Please pay by Cheque or Visa.
T- shirt (Please circle your size) S M L XL Accommodation(Please circle the categories which apply to you) 　　　　　Yes (UBC student housing / Hyatt Regency Vancouver)　　　　　　No How to pay　　　Cheque / Visa
Visa card number　　　　　　　　　　　　expiry date　　　　　　　　　　　name
All persons attending the 15th International Shiatsu Conference participate on a purely volunteer basis. As a volunteer, each participant shall assume all risk and potentially related liability in relation to their involvement in the Conference. I, the undersigned, hereby release and forever discharge the Japan Shiatsu College and the Canadian College of Shiatsu therapy and any of its employees, officers and agents from any liability, now or in the future, arising out of accident, illness, injury, of death, in any way connected with damages relating to any acts of omission of errors of a Shiatsu practitioner or student under their direction. I authorize Japan Shiatsu College and the Canadian College of Shiatsu Therapy to take necessary action in case of emergency. I accept responsibility for disclosing any existing medical problems to the practitioner and to ascertain, from a medical doctor, if there is any reason why I should not receive Shiatsu treatments. Sale and promotion of products and other therapies or services not approved by the conference organizers is prohibited. I agree to the conditions of this application. Signature 　　　　　　　　　　　　　　　　　　　　　　　　　　　Date
Please apply by mail to the following address. If you pay by cheque, please enclose the cheque with this application form. If you pay by Visa, you can also apply by fax or e-mail. If you apply by e-mail, you must sign your name on the waiver form again on the day of the conference. Mailing address: Canadian Shiatsu Society of BC #101 Lonsdale Quay Market 123 Carrie Cates Court, North Vancouver, BC V7M 3K7 Fax: 604-904-4183 E-mail: info@shiatsucollege.org ※ No applications will be accepted on the day of conference. Please bring T-shirt, Long stretch pants (No Sleeveless tops, No short pants, No jeans). 　 We will sell commemoration T-shirts and several books on SHIATSU for this conference. Please be sure to buy them as souvenirs.