Moment of Death Workshop Registration Form

Please copy, paste, print and send to the below address.

Helping at the Moment of Death Workshop Registration Form

Registration ends on March 15, 2017. Limited Enrollment.





City, State, Zip




I have read and understood the Cancellation Policy and Disclaimer of Responsibility below.



Enclosed is my check for $275 payable to Patricia Shelton.

Please mail checks:

C/O Melissa Lewis, RN BSN, 46 Churchill Rd, Wethersfield, CT 06109

Cancellation Policy: As Ms. Shelton will be traveling from a distance there will be no refunds on registration, unless due to cancellation.

Disclaimer of Responsibility: By registering for this program the seminar member specifically waives any and all claims of action against the Buddhist Faith Fellowship, Inc., Patricia Shelton and staff for damages, loss, injury, accident, or death due to negligence on the part of any organization or employee providing services included in this seminar.