2012 MAHILA BHAJAN SAMMELAN

SHREE RAMKABIR MANDIR, CARSON, CALIFORNIA

INDIVIDUAL REGISTRATION FORM

NAME: ________________________________________________________________

ADDRESS: _____________________________________________________________

CITY, STATE, ZIP CODE: _________________________________________________________

TEL. NO.: (HOME) ________________________ CELL PHONE: _______________________

EMAIL ADDRESS: ______________________________________________________________

VILLAGE/GAAM IN INDIA: _______________________________________________________

NAME OF BHAJAN GROUP: ______________________________________________________

PLEASE MAIL YOUR COMPLETED REGISTRATION AND RELEASE OF LIABILITY FORMS to: Minaxiben I. Patel

1248 E. Lincoln Ave

Anaheim, CA 92805

RELEASE FROM LIABILITY

I, the undersigned, understand, acknowledge and agree as follows:

I have voluntarily requested to participate in Shree Ramkabir Mandir’s 2012 Mahila Bhajan Mandal, at 530 East 231st Street, Carson, California 90745 (“Sammelan” or “Event”) beginning Friday, April 27, 2012 through to and including Monday , April 30, 2012.

As consideration for being permitted by Shree Ramkabir Temple, Inc. (“Mandir”) to participate in this Event and the use of its facilities, I hereby (a) agree that I, and my heirs and assigns, will not make a claim against, sue or attach the property or assets of the Mandir, its Volunteers (as defined below) and/or Hilton Hotel (5711 W. Century Blvd., Los Angeles, CA 90045) for property damage or loss, personal injuries or death, or damages or losses of any other kind without exception (together, “Injuries”) resulting from my participation in this Event at Shree Ramkabir Mandir ,including but not limited to, during transportation from the Hotel to Shree Ramkabir Mandir and back, and (b) I hereby release unconditionally and without reservation of any kind the Mandir, its Volunteers and Hilton Hotel from any and against any and all causes of action without exception that I, and my heirs and assigns now have or may have hereafter for any kind of Injuries arising out of, relating to, resulting from or in connection with my voluntary participation in this Event.

I further agree to indemnify and hold harmless the Mandir, its Volunteers and Hilton Hotel from any and all claims, liabilities, and expenses (including attorney’s fees and court costs) without exception arising out of or resulting from a breach of this Agreement by me or from any Injuries I may sustain during this Event at Shree Ramkabir Mandir, including but not limited to , during transportation from the Hotel to Shree Ramkabir Mandir and back.

I assume any and all risks of any Injuries ( including but not limited to injury to me or my death) that may occur at any time or place during this Samellan at the Mandir, the Hilton Hotel or at any other place during or in connection with this Event at Shree Ramkabir Mandir, including but not limited to , during transportation from the Hotel to Shree Ramkabir Mandir and back.

The term Volunteers shall include, without limitation, the trustees, officers, mahila mandal committee members and organizers, employees, agents, and members of the Mandir, as well as each and every person or entity who will assist in any manner to organize this Event or who will provide any food, transport or services in connection with this Event at Shree Ramkabir Mandir, including but not limited to , during transportation from the Hotel to Shree Ramkabir Mandir and back.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. TO THE EXTENT I DO NOT READ OR UNDERSTAND ENGLISH, IT HAS BEEN ADEQUATELY EXPLAINED TO ME IN A LANGUAGE THAT I UNDERSTAND. I AM AWARE THAT THIS AGREEMENT IS AN INDEMNITY AND A FULL RELEASE OF LIABILITY BETWEEN MYSELF AND THE MANDIR, ITS VOLUNTEERS, AND HILTON HOTEL.

I AM VOLUNTARILY PARTICIPATING IN THE SAMELLAN AND AM SIGNING THIS AGREEMENT OF MY OWN FREE WILL.