RSVP Form for Dr. Monica Scheel Dermatology's  Restorsea Patient Event on March 15, 2024
Date: Friday, March 15, 2024
Event #1: 1:00pm
Event #2: 3:00pm
Please fill out the information below to register for our Restorsea Patient Event!
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Email *
First and Last Name *
Which Event Would You Like to Attend?
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Phone Number (Mobile Preferred)
Optional: Which Restorsea Products Are you Most Interested in Learning About?
Photo/Video Release Consent for Media Use
For valuable consideration received, I hereby give Dr. Monica Scheel Dermatology the absolute and
irrevocable right and permission (with respect to the photographs and video that have been taken of me or
in which I may be included with others), to use photographs or video of me and authorize Dr. Monica
Scheel Dermatology, licensees, legal representation and transferees to use and publish photographs, video,
or images herein described in any and all forms and media and in all manners including advertising,
publishing, website and other form of internet use, for any product of services, or other lawful uses as may
be determined by Dr. Monica Scheel Dermatology.
I further waive any and all rights to review or approve any of the images, and written copy or finished
product. I am over the age of eighteen (18) and have read and fully understand the terms of this release.

If You Consent to the Above Photo/Video Release for Media Use, Type Your Full First and Last Name in the Box Below. This shall serve as your electronic signature. 
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Registration Acknowledgement:

By completing and submitting this registration form, you acknowledge and agree that your registration is not a legally binding agreement and does not guarantee your attendance at the event. Event organizers reserve the right to accept or reject any registration, and attendance at the event is subject to the event's terms and conditions. Event organizers may, at their sole discretion, cancel or modify the event, change event dates or venues, or take any other actions they deem necessary without liability.

If you understand and agree to the terms, please type your full first and last name in the box below. This shall serve as your electronic signature.
 *
A copy of your responses will be emailed to the address you provided.
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