2018/2019 Flu Season Boost Program - Waiver + Order Form, Edi Pfeiffer

Homeopathic Flu-season Preparation: 2018-19 Immune Boost Program

Program Order & Waiver Forms - Edi Pfeiffer

Almost finished - We have just two additional tasks for you to complete!

You'll need to read & sign a waiver form for your practitioner, and
You'll need to make payment for your program enrollment.

We have made provisions for you to do everything online, including electronically signing the form and processing your payment via PayPal. If you prefer to do so, you can print out the form for your records or save a copy on your computer. You can also pay your practitioner directly with cash or check. You'll find instructions for doing so at the bottom of this form.

Thanks so much!!

Your Name*

Email Address*

Waiver Form Instructions:

The waiver form is a 3-page pdf document.We have made provision for you to electronically sign at the bottom of this page, so there is no need to print unless you wish to do so for your records. (To print, click the "full screen" icon in the upper right-hand corner of the form and download or print from the new window.)

Please review the form, and then complete the fields at the bottom of the page for name(s), date and signature.

Waiver Form Edi Pfeiffer

In the spaces below, please enter the name(s) of the person for whom you are completing the waiver form.

Your Name*

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I understand that my participation in this program is confidential and that all data provided to my HP Supervisor will be held in confidence. I also understand that some of the anonymous data derived this program may be used in a future publication.*

I understand and agree.Please do not include my data.

I have read & understand the Waiver form for Edi Pfeiffer - Sign Below*

Today's Date*

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