Clinical Neurodynamic Solutions MALVERN 2023 Clinical Neurodynamics Registration Step 1 of 2 50% Name(Required) First Last Email Address(Required) MobileCompany(Required) Job Title Certification Tyle(Required) ATC CHT CSCS OT OTA PT PTA STUDENT OTHER License Number(Required) Office Location(Required) UPPER & LOWER QUARTER COMBINED COURSE(Required) Price: Terms & Conditions (Consent to Use of Likeness and Waiver of Liability, Express Assumption of Risk) Please review the following Terms and Conditions carefully prior to providing your acknowledgement below.(Required) I acknowledge that I have read the foregoing, or have had it read to me, and I fully understand its contents and significance, and voluntarily agree to be bound to the terms and conditions set forth above, without recourse or promise of any kind.Professional Seminars Ltd. CONSENT TO USE OF LIKENESS I, being of full age and majority, do hereby consent to allow Professional Seminars Ltd. and its affiliated entities (collectively, “PSL”), to use, re-use, utilize and disclose my testimonial, statement, likeness, photograph, video-recorded image, voice, name or any other pictorial image (collectively, “Likeness”) in conjunction with PSL educational training, business efforts, marketing, materials and/or programs, regardless of the chosen medium for Likeness, including, but not limited to, written statement, video or photographs taken for education, training, marketing, clinical enhancement or as an internal business tool, or as a tool to enhance general health, healthy lifestyle and/or well being (collectively, “Use of Likeness”). I do hereby acknowledge that I will not receive any payment or other consideration for PSL’s Use of Likeness. I do hereby release and forever discharge PSL and its officers, directors, shareholders, members, partners, agents, employees, subsidiaries, affiliates, related organizations, successors and assigns, of and from any and all manner of actions, causes of action, suits, proceedings, accounts, controversies, agreements, promises, damages, judgments, executions, claims and demands whatsoever, regardless of source or nature, whether known or unknown, in law or in equity, against them or any of them, arising out of or in any way related to this consent. Professional Seminars Ltd. WAIVER OF LIABILITY, EXPRESS ASSUMPTION OF RISK AND RELEASE In consideration of my participation in the Professional Seminars Conference (“Seminar”), I acknowledge that I understand the nature of the Seminar, namely educational training, which may also include, but is not limited to, hands on activities, such as return to play drills, weight lifting, performance of manual techniques, joint manipulation and other treatment techniques, which may be performed by me or on me by other Seminar attendees (collectively, “Course”). I acknowledge that I am in good health and in proper physical condition and therefore qualified to participate in Course. I fully understand that the activities that I will be participating in during Course involve risk of serious bodily injury, including, but not limited to, permanent disability, paralysis and death, and that these and other risks may be caused by my own actions or inactions, or the actions or inactions of other Seminar attendees participating in Course, the conditions and location in which Course takes place, or the negligence of the Released Parties (as hereinafter defined), and that there may be other risks either known or unknown to me, or not foreseen by me, and I fully accept and assume all such risks and all responsibility for losses, costs and damages I may incur as a result of my participation in Course. I acknowledge that Course is offered to me as educational training designed to enhance my clinical skills, knowledge and/or technique. I agree and understand that Professional Seminars Ltd., its staff, employees and/or designated personnel (collectively, “PSL”) are not providing any medical or clinical care. As such, Course is not intended to be nor shall it be construed to be any form of therapy, medical service, medical evaluation and/or medical examination. In recognition of the foregoing, I agree that neither PSL, nor any of PSL’s officers, directors, shareholders, members, partners, agents, employees, subsidiaries, affiliates, related organizations, successors and assigns shall be liable for any damages resulting from my participation in Course. I further waive any claim or cause of action against PSL and any of PSL’s officers, directors, shareholders, members, partners, agents, employees, subsidiaries, affiliates, related organizations, successors and assigns for my participation in Course. Thus, I hereby release, discharge and covenant not to sue PSL and its respective officers, directors, shareholders, members, partners, agents, employees, subsidiaries, affiliates, related organizations, successors, assigns, volunteers and any sponsors and advertisers associated with or participating in Course (collectively and individually, “Released Parties”) from all liability, claims, demands, losses or damages whatsoever, regardless of source or nature, whether known or unknown, in law or in equity, against them or any of them, caused or alleged to be caused, in whole or in part, by the actions or negligence of the Released Parties. If I, or anyone on my behalf, make a claim against any of the Released Parties, I will indemnify, defend, save and hold harmless each of the Released Parties from any loss, liability damage or cost which may be incurred by the Released Parties as a result of such claim.Total Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Payment Method(Required)PayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name High performance rehab for high performing individuals Get in Touch It looks like Javascript isn't enabled in your browser. Please enable it in order to fill out this form. OPEN HOURS Garnet Valley Monday - 8a - 6pTuesday- 12p - 6pWednesday – 8a - 6pThursday – 8a - 6pFriday - 8a - 4p Malvern Monday - 8a - 3pTuesday - 9:30a - 6pWednesday – 9:30a - 6pThursday – 8a - 6pFriday - 8a - 5p CLINIC LocationsGarnet Valley: 1451 Conchester Hwy, Garnet Valley, PA 19060Inside Ascent Athlete Malvern: 17 Ravine Rd Malvern, PA 19355Inside Everfit Gym 484-800-8186 info@precisionperformancept.com