Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Buzzer Code Email * Phone * (###) ### #### Birthdate * Required by WSET MM DD YYYY Gender * Male Female Special Needs Have you previously taken any WSET Courses? Click all that apply WSET Level 1 Award in Wines WSET Level 1 Award in Spirits WSET Level 2 Award in Spirits WSET Level 3 Award in Spirits Restaurant Select one Olivea Riva How did you hear about us? * Select all that apply Web Search Social Media WSET Website Word of Mouth Other CANCELLATIONS AND REFUNDS Cancellation up to 15 days from the start of class will receive a full refund. Cancellation between 3-14 days prior to the start of class will receive a 50% tuition refund. Any cancellations made within 3 days of the start of class forfeit the full tuition. I have read and understood the cancellation and refund policies. * Yes WAIVER AND RELEASE OF LIABILITY I have chosen to voluntarily participate in this program, and acknowledge that this document is a binding legal agreement that waives my legal rights. I understand that the Program involves the tasting of wine. I am aware of the risks and hazards associated with or related to consuming alcohol. Furthermore, I am aware that the effects of alcohol can be severe, including impairment of my motor skills and judgment. I accept full responsibility in the event that my actions are affected by any alcohol I have chosen to consume. In consideration of the Releasees allowing me to participate in the Program, I agree: (a) to freely accept and assume all risks, dangers and hazards arising out of, associated with or related to my participation; (b) to be solely responsible for any injury, loss or damage that I might sustain while participating; and (c) to forever release the Releasees from liability for any and all claims, actions and costs that might arise out of my participation, even though such risks, injuries, loss, damage, claims, demands, actions or costs may have been caused by the negligence of the Releasees. I acknowledge that I have read the Program description, the conditions of my registration and participation, and this agreement in its entirety. I have executed this agreement voluntarily, and understand that this agreement is to be binding on myself, my heirs, executors, administrators and representatives. * Yes Thank you for registering! Your space will be confirmed as soon as we receive payment in full. WSET Level 2 Award in WinesRegistration Form and WaiverBlack Dog Tavern
