Garden Photography Workshop Registration Contact InformationName* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Email* Workshop DetailsCamera Make and Model*Workshop Goals*My goal is to provide you with a great learning experience. Please share with me some of your personal goals for this workshop.We may walk 2-5 miles during the workshop. Do you have any known health restrictions that may prevent you from participating?*YesNo* If you answered "Yes" above please describe.*Comments or Questions?If you have any questions or concerns please feel free to enter in the above box.ACKNOWLEDGMENT AND ASSUMPTION OF POTENTIAL RISK1. Release and Indemnification: I recognize that participating in photography or other outdoor activities and related transportation involves risk of an accident and serious injury to me. I understand and acknowledge that this Activity and any related activities, by their very nature, pose the potential risk of serious injury/illness/death to individuals who participate in such activities. I understand and acknowledge that some of the injuries/illnesses which may result from participating in this Activity include, but are not limited to, the following: sprains/strains, paralysis, fractured bones, loss of eyesight, head and/or back injuries. The above list is not intended to be inclusive of all injuries that may occur, but rather to inform me of the types of risks inherent in my participation in the Activity, so that I can make a voluntary choice to participate or not participate. I also realize that the Activity may be strenuous, and that I have the option to seek the advice of a physician before I participate in this Activity. I expressly assume all risks of participating in Batdorff Photography-sponsored activities, whether those risks are known or unknown to me. I hereby voluntarily waive any claim against the Batdorff Photography, its officers, agents, servants, or employees from any liability or responsibility for any death or injuries that I might sustain which is incident to and/or associated with preparing for and/or while participating in any activity in any way connected with said Activity, including travel to and from Activity locations. I understand and acknowledge that in order to participate in this Activity; I agree to assume liability and responsibility for any and all potential risks which may be associated with participation in such activities. 2. Authorization of Medical Care: In the event I am in need of any emergency medical treatment to protect my health and welfare while participating in sponsored activities, I hereby authorize and agree to allow any authorized agent of Batdorff Photography to consent to and authorize the administering of such necessary emergency medical treatment. I acknowledge and agree that the release of liability and indemnification provisions set forth above shall apply to any authorization and consent to medical treatment made on my behalf by Batdorff Photography LLC or its authorized agents. I agree to be personally responsible for all costs of medical treatment (including emergency services) and other expenses thereby incurred. 3. I grant to Batdorff Photography LLC ("Photographer") the absolute and irrevocable right and unrestricted permission concerning any photographs that he/she has taken or may take of me or in which I may be included with others, to use, reuse, publish, and republish the photographs in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including illustration, promotion, art, editorial, advertising, and trade, without restriction as to alteration; and to use my name in connection with any use if he/she so chooses. I release and discharge Photographer from any and all claims and demands that may arise out of or in connection with the use of the photographs, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Photographer, as well as the person(s) for whom he/she took the photographs. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns.Agreement* I hereby agree to the above terms and I acknowledge and understand that my participation in this class is voluntary. Add me to the Batdorff Photography mailing list! Payment InformationGarden Workshop Dates:*June 8, 2019Garden Workshop- $165.00 Payment in full must be received 14 days prior to the workshop departure. Full refund with be granted with 14 day cancellation notice via phone or confirmed email receipt. No refunds granted for less than 14 days notice. Payment Method*PaypalCredit CardGift CertificateGift Certificate Number*Have a referral coupon? Enter it here. Total $ 0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. TweetSharePin0 Shares