I understand that Tai Chi is a gentle exercise which may enhance my physical fitness and improve my condition.  I confirm that my physical condition is fit to safely participate in this workshop.

In consideration for admission to this workshop (a) I hereby accept full responsibility for and assume the risk of any injuries sustained because of my participation in this workshop or practice or lessons involving Tai Chi and (b) I hereby release and hold harmless the instructors and all personnel in association with the Tai Chi Workshop for any liabilities, injuries and expenses which may arise as a result of participation in this workshop or practice or lessons involving Tai Chi.

I consent to the use of any photographs or videos taken of me, as well as any feedback or written comments by me in connection with the Tai Chi Workshop, for publicity, promotion, demonstration or other business purposes, in any medium, including the internet, and I waive any right to compensation in connection with such use.

Signature of Workshop Participant

_____________________________________________________Date______________

Print Full Name __________________________________________________________

Fees: $35.00 includes morning and afternoon tea breaks. $20.00 with Student ID. Bring your own lunch. Advanced registration suggested or arrive 30 minutes early. Cash or check payable to : Stephanie Taylor MD, P.O. Box 222580, Carmel, CA 93922.

Dress in loose fitting clothes and light flat shoes.