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MICHIGAN MAGAZINE

EXPO 2002
JUNE 29TH, 30TH, 2002

BASIC EMERGENCY FIRST AID AND CPR PRESENTATION


RELEASE OF LIABILITY

I, the undersigned, hereby register to attend a presentation on Basic Emergency First Aid and Cardiopulmonary Resuscitation (CPR).

By signing this registration form, I hereby release Michigan Magazine, it's employees, and the CPR instructor from all and any liability from any injury received during the above instructdion and subsequent use of information provided.

I also acknowliedge that this is a demonstration of emergency procedures for first aid and CPR, and that I have been informed that it is advisable I attend an official CPR course presented by the American Heart Association, the American Red Cross, or other nationally recognized provideer of emergency assistance.

NAME OF ATTENDEE___________________________________

SIGNATURE OF ATTENDEE______________________________(DATE)___________

EMAIL:________________


Print this form - fill out - Sign and FAX (PREFERED) to:

(775) 254-3757

OR SEND VIA US MAIL TO:

MICHIGAN MAGAZINE EXPO EVENT

BOX 503
ROSE CITY, MICHIGAN
48654