AGREEMENT FORM


  Agreement:


   I will hold harmless the coordinators and project planners of the Window Pane Project, 
   releasing them from all liability including but not limited to: representation, reimbursement,  injury
   or loss. 
   I have read the Application Agreement and agree to these terms.

Name (Last, First)

Mailing Address
City, ST, Zip Code

**Shipping Address
City, ST, Zip Code

Home Phone
Cell Phone


E-Mail Address

WEB Site

BLOG Address

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