網上學員報名表(Online registration) 網上學員報名表(Online registration) Leave this field blank 報名注意事項 (Attention) (optional) 標記 '**' 為必需填寫欄目,若是沒有填寫該欄目,則無法完成報名手續。報名完成後請確認本系統確認報名完成通知! 人能靜坐法乃為非營利機構,免費傳授健康益養生靜坐法 If column marked with '**', it must be filled with information, otherwise online registration cannot be completed. Please make sure you got registration completed message before leaving this site. HEM is a non-profit organization, HEM class is free of charge to all students. **Location - select one 請勾選一個(required) 爾灣 Irvine 哈仙l達崗 Hacienda Hts. 北嶺 SF Valley 台湾 Taiwan 其它 Others **Language 語言,可以多選 (required) 中文 English Espanol **Need English translation? 上課需要英文翻譯?(required) Yes No **Choose one Box 請勾選一個項目 (required) 新開課 New Class 重新複習 Refresh class 上課日期 Class Date (optional) 上課日期 7/28/2024 Please note that the information contained in this form will be used solely for internal purposes and will be kept confidential. **Enter your last name (姓) **Enter your first name(名) Nickname(中文名字) **Enter your email(電郵) **Enter your phone number(電話號碼) Mobile or Landline?(手機或座機?) (optional) Mobile Landline **性別 Gender (required) 男 Male 女 Femal Address(住址) (optional) Address **City State Zip Code **Emergency Contact person (緊急聯絡人) **Phone Number (緊急聯絡電話) Who referred you(介紹人) 專長/興趣/嗜好 (optional) **十年內曾患癌症?(Had cancer in the past 10 years?)(required) Yes (有) No (沒有) Participant Agreement (學員同意書) (optional) I absolve and agree to hold harmless, the Human Energy Meditation Center, its employees, officers, or agents from any liability which may result from my participation or that of any minor in my legal custody, in the mentioned activities: which may include but are not limited to meditation training, meditation teaching, meditation demonstration, training assistance, and teaching assistance. If the Participant is a minor, I also give my permission for his/her participation in the stated activities and for any necessary emergency medical treatment. (I hereby grant the Human Energy Meditation permission to use photos or videos taken during meditation activities in any and all of its publications, including web-based publications, without payment or other consideration.) 我完全同意放棄對人能靜坐法及其工作人員的任何法律訴訟權利及授權其在緊急醫療情況下的各項處理事宜, 無論是成人或孩童. (我特此授予人能靜坐法許可,允許在任何和所有出版物(包括基於網絡的出版物)中使用人能靜坐法/班活動期間拍攝的照片或視頻,而無需付款或其他考慮) I have read, understood and accept the rules and guidelines. 我可以遵守報名須知上所列要求 **如果你同意以上所述,請標記同意按鈕 If you agreed, please mark 'Agreed' botton below 同意 (Agreed) 報名日期 (Today's Date) Submit 人能靜坐法 7-28-2024 網上報名表