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  • The William L. Goldfarb Foundation (WLGF) is presenting a Continuing Medical Education Program entitled and described as indicated below.

    1. I agree that I am personally responsible for my safety and my actions. Because the program presented by WLGF  will involve speakers and other attendees, I recognize that I am at risk of contracting COVID-19. COVID-19 is a health condition that has caused illness and even death in individuals who have contracted the virus or condition. I am aware of the risks involved in attending the above-mentioned program and I, for myself and on behalf of my family, spouse, estate, heirs, executors, administrators, assigns, and personal representatives, hereby forever release, waive, discharge, and covenant not to sue the WLGF, its officers, employees, contracted agents or representatives, servants, independent contractors, affiliates, employees, successors, and assigns (collectively the “Released Parties”) from any and all liability, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of, or related to, any loss, damage, or injury, including death, that may be sustained by me related to COVID-19 whether caused by the negligence of the actions, or failure to act, of the Released Parties.

    2. I agree to indemnify, defend, and hold harmless the Released Parties from and against any and all costs, expenses, damages, claims, lawsuits, judgments, losses, and/or liabilities (including attorney fees) arising either directly or indirectly from or related to any and all claims made by or against any of the Released Parties due to bodily injury, death, loss of use, monetary loss, or any other injury from or  related to COVID-19, related to my participation in the WLGF program.

    3. By signing below I acknowledge and represent that I have read the foregoing Waiver of Liability, understand it and sign it voluntarily as my own free act and deed, including without limitation the Release of Liability and Indemnification requirements contained in this document; I am sufficiently informed about the risks involved in attending and participating in the WLGF program. No oral representations, statements, or inducements, apart from the foregoing written agreement, have been made to me. I am at least eighteen (18) years of age and fully competent; and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same. I agree that this Wavier of Liability shall be governed by and construed in accordance with Pennsylvania law, and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible and the unenforceable provision(s) shall be deemed modified to the limited extent required to permit enforcement of the Waiver of Liability as a whole. This waiver remains in effect until the Commonwealth of Pennsylvania, and the State of Montana State, lift all COVID-19 related mandates.

  • Meeting Participant (Minor)



  • Meeting Participant (Adult)

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Phone : 717-763-7665
Fax : 717-761-4091
The William L. Goldfarb Foundation 757 Poplar Church Road
Camp Hill, PA 17011