Laufer - Permission Agreement

Your profile requires an email address; additionally, we request that you allow us to send you general notices, including reminders of appointments, via e-mail. You can the read the complete agreement below the form. You will be able to remove your name from this list at any time and we will not provide your email address to anyone else.

Permission Agreement

I hereby authorize you to furnish to me general notices, including reminders of appointments a monthly newsletter, via e-mail at the e-mail address indicated above.

I understand that it is my obligation to inform you of any changes in my e-mail address after the date of sign-up. I further understand that my profile is protected under confidentiality regulations and that no confidential information will be included in any general notices sent to my e-mail address. I also understand that I may revoke this authorization at any time, in writing or by e-mail except to the extent that action has been taken prior to the revocation. Upon revocation of authorization further notifications by e-mail will cease immediately.