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Lymph Seminar Online Registration
Networking and Educational Workshop for Lymphedema Therapists
December 5, 2020
Hospital / Business Affiliation
BUSINESS Street Address
HOME Street Address
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Workshop Fee is $195 (7 Contact Hours)
(Please fill out separate form
CONSENT For photographs, film/video, recordings and written articles (stories):
I authorize Lymphedema Seminars to make photographs, film/videos or electronic recordings of me and to publish or otherwise use information about me.
I understand and agree that the films/videos, photographs, recordings and information may be used for publication and for other Lymphedema Seminars publication/productions in the future.
I do not place any limit on the period of time in which the photographs, films/videos, recordings or information may be used.
I understand that I will not receive any payment from Lymphedema Seminars as a result of the distribution, showing or other use of these photographs, films/videos, recordings or information.
I give my consent with the understanding that I may or may not be identified by full name in any photographs, films/videos or recordings which are made.
I understand the photographs, films/videos or recordings are owned by Lymphedema Seminars.
BY MY REGISTRATION FOR THE WORKSHOP, I CONSENT TO ALL THE ABOVE!
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