COMPLETE THIS FORM AND RETURN, WITH PAYMENT AND APPLICATION FORM TO:-
VIC. PAGAN, P.O. BOX 366, DIAMOND CREEK, VIC. 3089

DISCLAIMER (Please ensure that disclaimer is printed and signed on one page only)

I, the undersigned acknowledge that there are inherent risks associated with participating in activities which are intended to affect changes in the consciousness of those who participate.  I acknowledge that such activities are a part of the EUPHORIA gathering.  Therefore I, the undersigned, agree to occupy and use the premises of upon which the EUPHORIA gathering takes place at risk to myself and hereby release to the full extent permitted by law the organisers of the EUPHORIA gathering and their, agents, servants, contractors and employees from all claims and demands of every kind in respect of injury resulting from any accident or damage to property or injury or death of myself occurring in the premises of the buildings and grounds for which the organisers of the EUPHORIA gathering and their, agents, servants, contractors and employees are or could become legally liable.  I the undersigned will and do hereby indemnify the organisers of the EUPHORIA gathering and their, agents, servants, contractors and ees from and against all actions, claims, demands, losses, damages, costs and expenses for which the organisers of the EUPHORIA gathering and their, agents, servants, contractors and employees shall or may be or become liable in respect of or arising from:  Loss, damage, injury or destruction to any property of the undersigned which may be in the premises upon which the EUPHORIA gathering takes place.  And/or loss, damage, injury or death from any cause whatsoever to property or person caused or contributed to by the use of the premises upon which the EUPHORIA gathering takes place by the undersigned.  And/or loss, damage, injury or death from any cause whatsoever to property or person within or without the premises upon which the EUPHORIA gathering takes place or the buildings or grounds occasioned or contributed to by an act, omission, neglect, breach or default by the organisers of the EUPHORIA gathering and their, agents, servants, contractors and employees, invitees or licensees to the undersigned.

I the undersigned do hereby acknowledge that I am over eighteen years of age and that I have read and understood this disclaimer and the EUPHORIA gathering CODE OF CONDUCT and agree that I shall abide by them.

Signature of Applicant: Date of signing

Signature of Witness: Date of signing