TO REGISTER, PLEASE PRINT THIS FORM.

Grandmaster Lim, Hyun Soo Hapkido & Kuhapdo Seminars 2007
Assumption of Risk Agreement, Release and Consent
Read Carefully Before Signing

Name: ___________________________Email:________________Phone #:___________

Address:________________________________ City, State, Zip_________________

Date of Birth:___________ Style(s): __________________________Rank(s):_________

Any physical disabilities?  Yes______  No______ (If yes, list here)_______________

_______________________________________________________________________


The undersigned, _______________________________(fill-in your first and last name)assumes all
responsibility and risk for any and all of damages, injuries, or losses that the undersigned may sustain
or incur while, attending, participating in exercises/techniques or using the training equipment or
facilities,  and traveling to and from the Hapkido and/or Kuhapdo (sword) seminars. I, the undersigned
hereby releases, discharges, and waives  all claims, demands, rights of causes of action, present or
future, whether known, anticipated or unanticipated, and resulting from or arising out of, or incident to
my (the undersigned and participant) use (or intended use) of  the techniques taught at this seminar(s)
against title sponsors, promoters, organizers, operators, hosts, schools, owners, officers, directors,
employees,  black belts, instructors, masters, students, other participants, agents, affiliates,
Grandmaster Lim, the Jungki Kwan, Grandmaster Lim's Korea Jungki Hapkido & Kuhapdo Association,
Iron Eagle Hapkido & Karate Inc., Safe, Inc., Master Michael D’Aloia, and Master Sheryl Glidden.
I understand that Hapkido & Kuhapdo are physical activities that require the participant/undersigned to
be in good physical health. Al participants should consult a health care professional before
undertaking any physical activity.  I understand that martial arts training is dangerous.
My participation in this seminar(s) is voluntary.  Furthermore, I understand that my participation in this
seminar will automatically authorize the organizers permission to use any photographs or video taken
during the seminar for personal or public usage such as promotion, articles, show, and advertising
without additional consent and without compensation at this time or any other time. I also understand
that no videotaping or photography will be allowed during this seminar.  
I understand that no refunds will be issued.

I have read and understand and sign the foregoing assumption of risk agreement, and release and
consent.

Participant’s Signature_______________________________________________

Participant's Name:(Please print.)_______________________________________

Parent/Guardian Signature if Participant is a Minor__________________________
Parent/Guardian Name (Please print.)_____________________________________         
NJ-HKD - Sat. July 28th         $115.00   _____

NJ-HKD - Sun. July 29th        $115.00   _____

NJ- HKD- Sat. & Sun.             $210.00   _____

NH- KHD- Fri., Aug. 3rd          $100.00   _____

NH- HKD - Sat. Aug. 4th         $115.00  _____

NH - HKD & KHD                     $200.00  _____

2 HKD - 1 NJ- 1 NH                 $210.00______

3 HKD - 2 NJ & 1 NH              $300.00______

ALL 4 SEMINARS - NJ/NH    $400.00  ______

Yes, I would like to have to
pre-order a video or dvd.
It will be available for pick-up
at seminar.
The 3 HKD dvds are the requirements for
White to Black Belt in Jungki Hapkido.

(Please read WARNING
prior to ordering videos/dvds.)

Orthodox Hapkido Vol. 1         $50.00______
White/Yellow Belt Tech.
____DVD  _____Video

Orthodox Hapkido Vol. 2
Blue/Red Belt Tech.                $50.00______
____DVD  _____Video

Orthodox Hapkido Vol. 3
Purple Belt Tech.                    $50.00______
____DVD  _____Video

Orthodox Kuhapdo (Sword)
____DVD  _____Video           $50.00______

Grandmaster Lim
Seminar T-Shirts

1 for $15.00                            $15.00______
Size (Adult-M, Ad,-L, Ad.-XL ,
XXL,  XXL)                                 Size________

2 for $25.00                            $25.00______
Size (Adult-M, Ad,-L, Ad.-XL,
XXL, XXL)                                 Size________

Total Enclosed                             ________

Check or money order payable to:
Iron Eagle/Safe Hapkido.

SEMINAR REGISTRATION
Mail this registration form with check
or money order made out to
Iron Eagle/ Safe, Inc.
Postmarked by June 1, 2007

Iron Eagle Hapkido 26 Lakeside Ave.
(Rear) Pompton Lakes, NJ  07442

For further info contact:
Master Mike D’Aloia (201) 320-4067
hapkido@optonline.net  or
Master Sheryl  Glidden (207) 831-1885
jungki2@aol.com
PLEASE CHECK & TOTAL.
New Jersey


Pompton Lakes Area- Northern NJ
Location: TBA

Hapkido   Sat.,  July 28th -  12-4 p.m.
             Sun.  July 29th -   12-4 p.m.

One Day- $115*   Two Days - $210

DIFFERENT HKD MATERIAL WILL BE  
TAUGHT ON SAT. & SUN.
******************************************
New Hampshire

Dover/Portsmouth Area
Location: TBA

Kuhapdo (Sword)- Friday, Aug. 3rd
                         6:30-9:30 p.m.
$100.00*

Participants must bring their own wooden sword.
WOODEN SWORDS ONLY. Limited swords
available to borrow.

Hapkido- Sat., Aug. 4th
            12 p.m.- 4 p.m.

$115.00*

Two Days in New Hampshire- KHD &HKD -
$200.00

NJ & NH - ALL 4 seminars 3 HKD, 1 KHD -  $400.00

EARLY REGISTRATION DEADLINE:  6/1/07.

Registration will be accepted at the door,
however discount rates do not apply.  No
discounts for registration received after 6/1/07)
No refunds will be issued. Checks will not be
accepted day(s) of seminars.- Cash only.

Credit card payment accepted via PAYPAL:
admin@jungkihapkidoamerica.com

Checks or money orders payable to Iron
Eagle/Safe Hapkido.
MEMBERSHIP

TO JOIN THE KOREA JUNG KI
HAPKIDO & KUHAPDO ASSOCIATION
OF AMERICA, PLEASE VISIIT
WWW.JUNGKIHAPKIDOAMERICA.COM
NAME_________________________________  PHONE #________________
www.jungkihapkidoamerica.com