REGISTRATION FORM
Print this page and register for your BT event.
BT Event You Want To Attend ________________________________________________
NAME ___________________________________________________________________
Address___________________________________________________________________
City ________________________________State _____________Zip__________________
Phone _____________________________ E-Mail _________________________________
Tuition Enclosed_____________________________________________________________
By my signature on this application, I state that I am 18 years of age or older and
that I agree to assume all responsibilities for all risk of damage or injury that
may occur to me as a participant in this event. I hereby, for myself, my heirs, executors
and administrators, release and discharge Brothers Together®, A Weekend with
Our Brothers, and all persons associated with this event from all claims, damages,
causes of action, present or future, known or unknown, anticipated or unanticipated,
which result from, or arise out of, or are incident to my participation in this event.
Our refund policy is: Your conference fee, less $30, will be refunded with at least
7 days notice. No refunds with less than one weeks notice.
Signature:_____________________________________________________________________
Checks Payable To: Brothers Together
Mail to; Brothers Together, 115 Newbury Street #204, Boston MA 02116-2935
(For Info 617-247-3964)
DIRECTIONS AND CONFIRMATION WILL BE SENT BY E-Mail
IF YOU WANT POSTAL CONFIRMATION CHECK HERE________