Click here to register an individual

• You may either register online, using the link above, or please print this page, and fill it out and mail it in with your payment. Please make checks out to Karl D. Lehman, MD.

Mail the form to:

Karl D. Lehman, MD
P.O. Box 6002
Evanston, Illinois 60204
USA

Registration Form

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First name, Last name

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Address

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Address

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City/State/Postal Code

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Country

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Email / Phone #

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Group Name , if registering a group of six to eight people

TO REGISTER MORE THAN ONE PERSON: Please include the above information for each attendee.

PAYMENT (All prices are listed in US dollars):

Individual Registration $60 X _________ (number of persons) =_______________

For all registrants:

Please make checks out to Karl D. Lehman, MD, or fill in credit card information below, and mail to the address above.

Release regarding the Recording of the Event:

I, the undersigned, understand that my voice or image may appear in the recording of the Lehman March 28, 2009 seminar in Libertyville, Illinois, for which I am registering. I hereby release all rights to the video and audio recording of the seminar, and I specifically give the Lehmans permission to use any recording in which I appear or am heard, in the production of their video or other media product. This release will not expire at any time in the future, and also applies to any of my heirs and assigns.

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Signature and Date

Please note that all attendees must sign the above waiver before attending the seminar. It may be signed here, and mailed in with your registration, or attendees may sign it at the door when they check in on the day of the event.

Thanks! We look forward to seeing you!

Cancellation Policy: Cancellations made by March 7th 2009, will be refunded less a $25 USD processing fee per transaction. No refunds for cancelled registrations will be made after March 7th 2009. Please note, however, that paid registrations may be transferred to another person. Please notify us if you find you must cancel. If you find someone else to whom to transfer your registered spot, we need to know that person's name and contact information.