SSEHV Introductory Workshop for Physicians Pre-Workshop Questionnaire - Dec 2020

Note: Please ensure to sign the consent form below after you are done submitting the form below.
Loading…

Note: Please ensure to sign the consent form below after you are done submitting the form above.

Photograph and Media Consent Form I hereby consent to the Institute of Sathya Sai Education-USA or its designated and authorized person(s) taking digital images, and/or audio or video recordings when I am engaged in SSEHV/EHV or SSEHV/EHV-related activities. Furthermore, I agree and consent that ISSE-USA Course work and Fieldwork/Practicum lesson plans, digital images, audio and video recordings, etc., shall be the property of the Institute of Sathya Sai Education-USA. The ISSE-USA has the right to duplicate, reproduce, and otherwise use these images/recordings/course-related work for purposes associated with the Mission of the ISSE-USA, which may include professional development, publications, websites, or print and electronic media. We will cite the author whenever using Course work and lesson plans and not use any such items beyond what is described above. In all cases, the ISSE-USA Director will expressly authorize all uses. I hereby release the ISSE-USA from any liability for the use or distribution of these aforesaid images, etc. as authorized in this form.
Name (Please Print)*

Please enter your full name
Signature*

Please print your name (e sign is acceptable)
Date*
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*

SSEHV Introductory Workshop for Physicians Pre-Workshop Questionnaire – Dec 2020