Join ZENTONICS™Fill out the form below to become a member. Registration is free and your privacy is respected. Name* First Last Email* Create a Password* Enter Password Confirm Password Strength indicator Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact Name* First Last Emergency Contact Phone*Accident Waiver and Release of Liability I acknowledge that ZENTONICS™ classes are physical exercise and that participating in these classes carries with it the potential for injury or property loss. I hereby assume all the risks of participating in these classes. I certify that I am physically capable of participating in these classes and have not been advised otherwise by a qualified medical person. I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter occur to me including traveling to and from classes: Holly Sweeney-Hillman. The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. By checking the box below, I certify that I have read this document and I understand its content. Have you read and understood the above waiver?* I certify that I have read the Accident Waiver and Release of Liability (above) and I understand the terms. PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.