Please fill out this form completely and return it within one week of receipt.  ●   The accuracy and completeness of your answers are important as a condition to your participation in this program.   ●    We will hold the information on this form in confidence.   ●    Please answer every question and sign your name in the appropriate place.

Consent Agreement: I am advised that the Facilitator Development Program is an educational seminar and not therapy, and accordingly, I have no expectations along these lines.  I am also advised that the Facilitator Development Program may include long hours and may be physically and emotionally demanding. I acknowledge that I have evaluated the advisability of taking the training in terms of all the history and circumstances of my life and I accordingly, agree to take full responsibility for the mental, emotional and spiritual well being I attain, as a result of the training.  I am fully aware that the Facilitator Development Program may bring up incidents from my past, which may be emotional for me.   I acknowledge and declare that I am voluntarily participating in the Facilitator Development Program.  I hereby release Origin of Wisdom and Dr. Annie Lim International Inc. its founders, trainers, employees, any and all other Facilitator Development Program participants and the premises in which Facilitator Development Program is held, from any and all liability as a result of any physical, mental or emotional injuries, or damage to personal property suffered by me either during or as a result of my participation in the Facilitator Development Program.
 
I also acknowledge that I am in good physical and mental health and condition and have no ailment, disability or impairment, which (might) prevent me from participating in the Facilitator Development Program.
 
If I am in therapy, I warrant and represent that I have discussed the training with my therapist, and have ascertained from him/her that my participation is not likely to aggravate or activate any symptoms, illness or disorders which I may have, nor would it be harmful to my health or well being to participate in the Facilitator Development Program.
 
Confidentiality: It is my understanding that Facilitator Development Program is an experience, private and personal to each participant, and I accordingly agree to respect the confidentiality of all the participants and to keep all material shared or discussed by them, private and confidential.
 
Payment and Refund Policy: It is my understanding that the program payment is due in full by registration unless otherwise negotiated in writing. If I am paying with a payment plan, I understand that I do not receive any discounts for tuition and I must pay the total price.
 
Cancellation Policy: In the event, I am not able to attend the program for which I have registered, I must notify the promoters in writing at least seven days before the program starts. Provided I notify them before the seven day period, I will have the option to attend the next Facilitator Development Program or apply my payments to another program under the Dr. Annie Lim International Inc. umbrella, or substitute myself with another person not already registered. Please note: All payments are transferrable only and are not refundable. These options are available to participants who have placed their deposits or paid in full.
 
Release:  I understand that the Facilitator Development Program may or may not videotape the program. I consent to and authorize Dr. Annie Lim International Inc. to use my name, voice, appearance, image, words and participation in whole or part in these recordings without compensation to me and that they may be used for educational and promotional applications.
 
By signing (or digitally signing) this document, I acknowledge that I have read and understand all of the above terms.  I freely and voluntarily agree to abide by all of these conditions.  Please send back (email, mail or by hand during registration) to RAIN or Dr. Annie Lim International Inc.