Grandmaster Lim, Hyun Soo Hapkido & Kuhapdo Seminars 2010 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 - Mon., June 28th (Kids) $45 _____
NJ-HKD - Mon. June 28th (Adults) $99 _____
NJ- HKD- Tues.,June 29th (Black Belts) $99 _____
NJ- HKD- Tues.,June 29th (Adults) $99 _____
Maine-HKD - Thurs., July 1st (Kids) $45 _____
Maine-KHD (Sword) Fri. July 2nd $99 _____
Maine-HKD Sat. July 3rd $110.00______
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) Sies________
Total Enclosed: ________
Check or money order payable to:
Iron Eagle/Safe Hapkido.
NJ-HKD - Mon. June 28th (Adults) $99 _____
NJ- HKD- Tues.,June 29th (Black Belts) $99 _____
NJ- HKD- Tues.,June 29th (Adults) $99 _____
Maine-HKD - Thurs., July 1st (Kids) $45 _____
Maine-KHD (Sword) Fri. July 2nd $99 _____
Maine-HKD Sat. July 3rd $110.00______
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) Sies________
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 May 31, 2009
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
MONDAY, June 28, 2010
Kids Hapkido Seminar
5:00-6:00 p.m.
Location: Iron Eagle Hapkido
26 Lakeside Ave. (Rear)
Pompton Lakes, NJ (973) 839-9700
Cost $45.00
(Includes GM Lim seminar T-shirt)
Hapkido
6:30-9:00 p.m.
Location: Iron Eagle Hapkido
26 Lakeside Ave. (Rear)
Pompton Lakes, NJ (973) 839-9700
Cost: $99.00
(Different HKD material will be
taught at each seminar.)
Tuesday, June 29, 2010
Hapkido- Jung Ki Hapkido Black Belts 1st Dan
and Higher
10 a.m.-12 p.m.
Location: Iron Eagle Hapkido
26 Lakeside Ave. (Rear) Pompton Lakes, NJ
(973) 839-9700
Cost: $99.00
Hapkido
6:30-9:00 p.m.
Location: Brian McCann’s Self Defense
Academy 4411 U.S. 9 Howell, NJ 07731(732) 886-
5556
Cost: $99.00
(Different HKD material will be
taught at each seminar.)
MAINE
Thursday, July 1, 2010
Kids Hapkido Seminar
5:00-6:00 p.m.
Cost $45.00 (Includes GM Lim seminar T-shirt)
Friday, July 2, 2010
Kuhapdo (Sword)
6:30-9:00 p.m.
Location: William H. Rowe School
52 School St. Yarmouth, Maine
Cost: $99.00
Saturday, July 3, 2010
Hapkido
12:00-3:00 p .m.
Location: William H. Rowe School
52 School St. Yarmouth, Maine
Cost: $110.00
REGISTRATION DEADLINE: 5/31/10.
Registration will be accepted at the door.
A $10.00 fee will be added for on-site registration.
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
Learn original Hapkido techniques
at these "hands-on" seminars!
All participants must wear a
uniform.
No spectators please.
Sword Seminar- Participants
please bring your own wooden
sword. Wooden swords only.
There will be limited swords to
borrow