REGISTRATION FORM
FOR THE STWS HERBAL DETOXIFICATION PROGRAM
SERVING THOSE WHO SERVE INC.
Name
Address  
street
city State Zip
Phones
1st 2nd
Email
1st 2nd
9/11 association (volunteer/organization)
 
For FDNY, NYPD and Dept of Sanitation:
Active
Retired
Not Applicable
Engine or Ladder
I, the undersigned, understand that the herbal supplements that I am receiving through SERVING THOSE WHO SERVE Inc., are a natural food supplement and not a medication. I agree to take the herbal supplements of my own free will, according to the written instructions provided, and without any obligation to SERVING THOSE WHO SERVE Inc. or anyone associated with the organization. I acknowledge that the healing process using Ayurvedic herbs can be a slow process with some detoxification symptoms. I therefore acknowledge that STWS, its members, officers or volunteers are not responsible for these symptoms. I also acknowledge that ultimately, my healing and the decisions toward that end are my responsibility and that of my chosen health professionals, and that SERVING THOSE WHO SERVE Inc., its officers, associates or volunteers, are not in any way responsible for the condition of my health. I also agree not to use these products for resale.
You should not see this check box, if you do, do not check it
(or right-click to save the form to your computer)
Mailing address for printed form:
STWS
345 W 86th Street, Suite 812
New York, NY 10024
 
© 2017 Serving Those Who Serve, Inc.