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RSVP Form for Dr. Monica Scheel Dermatology's ISDIN Patient Event on APRIL 19, 2024
Date
: Friday, April 19, 2024
Doors Open:
6:15 pm
Event Start Time:
6:30 pm
Dr. Monica Scheel Dermatology
73-5618 Maiau St. #A204 (2nd Floor)
Kailua-Kona, HI 96740
Please fill out the information below to register for our ISDIN patient event!
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Email
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Your email
First and Last Name
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Your answer
Phone Number (Mobile Preferred)
Your answer
Optional:
Which ISDIN Products Are you Most Interested in Learning About?
Retinal Advanced
Melaclear Advanced
Uradin Lotion
K-OX eye
Essential Cleansing
Eryfotona Ageless
Eryfotona Actinica
Melatonik
Micellar Solutions
Hyaluronic Concentrate
Skin Drops Sand
Skin Drops Bronze
New! Hyaluronic Moisture
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.
*
Your answer
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.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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