REGISTRATION for Invited Workshop

Alexander Technique Workshop

Active Learning: Skills to help manage symptoms of PD with Alexander technique

A workshop for people living with Parkinson's and their care partners.

Date: Saturday, 4 February 2018

Location: St John’s Wood Church, Lord’s Roundabout, St John’s Wood, London NW8 7NE

Closest Tube: St. John's Wood Station ~ Jubilee line
Next closest: Baker Street Station ~ Metropolitan, Circle, Hammersmith & City, Bakerloo, Jubilee

Time: 2:30pm - 4:00pm

PLEASE NOTE
This symposium is part of a training day for AT teachers. We will be videotaping it for educational purposes. By attending you are giving your permission for photos and video images that may be recorded of you at this event to be used for educational and promotional purposes by The Poise Project® and AT4PD.

Please wear loose clothing that allows you to move in a relaxed way. No need for exercise clothing!

Please fill out and Submit this Registration Form.

Thank you, and we look forward to seeing you at St John's Wood Church on Saturday, 3 February 2018 at 2:30pm!

Name

First Name

Last Name

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Please check one:

I am a person living with Parkinson's

I am a care partner of a person living with Parkinson's

Other

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RELEASE AND WAIVER I do hereby release, waive and discharge The Poise Project ("The Poise Project") and their affiliates, trustees, directors, officers, employees, volunteers, assistants and agents (“Releasees”) from any and all liability for injury, loss, damage, obligation, expense or penalty, including attorneys’ fees, that I may cause or sustain in connection with my participation in The Poise Project's one-to-one instruction, group classes, workshops, programs or events whether caused by the negligence or carelessness of Releasees or otherwise. I understand that Releasees do not have medical personnel available at their one-to-one instruction, group classes, workshops, programs or events, and I agree that Releasees assume no responsibility for any injury or damage that might arise out of or in connection with my participation with any of The Poise Project's activities. By signing below, I knowingly and voluntarily assume all such risks, and assume sole responsibility for any accident or injury to myself and other persons or property arising out of or in connection with participation in The Poise Project's one-to-one instruction, group classes, workshops, programs or events. In addition, I have adequate coverage under a health and accident insurance policy applicable to the activities in which I may engage. I further agree that any photos or videotape images taken of me during any of The Poise one-to-one instruction, group classes, workshops, programs or events may be used by The Poise Project for archival documentation, or for scientific or educational or publicity purposes. By agreeing to this Release and Waiver by indicating such in the check box below, I represent that I have read its contents, that I understand it and that I agree to it voluntarily as my own free act and deed. I further state that I am at least eighteen (18) years of age, am fully competent to sign this document and that I execute this Release in consideration of my participation in The Poise Project's activities and programs, fully intending to be bound by same. By submitting this form, I indicate my agreement to this Release and Waiver.

* PLEASE WRITE YOUR NAME BELOW TO INDICATE YOUR SIGNATURE AGREEMENT TO THIS RELEASE AND WAIVER.

London Training Day Workshop for PlwPD and Care Partners