Grandmaster Lim, Hyun Soo Hapkido & Kuhapdo Seminars 2005 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 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. June 25th $100.00 _____
NJ-HKD - Sun. June 26th $100.00 _____
Dinner - Sat. June 25th $40.00 _____
Must fill-out dinner form.
CLICK HERE FOR FORM.
ME- HKD- Wed. June 29th $60.00 _____
NH- KHD- Thurs. June 30th $60.00 _____
CT-HKD - Fri. July 1st $75.00 _____
MA-HKD Sat. July 2nd $100.00 _____
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 videos/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 $12.00 $12.00______
Size (Adult-M, Ad,-L, Ad.-XL Size________
2 for $20.00 $20.00______
Size (Adult-M, Ad,-L, Ad.-XL Size________
Total Enclosed ________
Check or money order payable to:
Iron Eagle/Safe, Inc.
NJ-HKD - Sun. June 26th $100.00 _____
Dinner - Sat. June 25th $40.00 _____
Must fill-out dinner form.
CLICK HERE FOR FORM.
ME- HKD- Wed. June 29th $60.00 _____
NH- KHD- Thurs. June 30th $60.00 _____
CT-HKD - Fri. July 1st $75.00 _____
MA-HKD Sat. July 2nd $100.00 _____
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 videos/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 $12.00 $12.00______
Size (Adult-M, Ad,-L, Ad.-XL Size________
2 for $20.00 $20.00______
Size (Adult-M, Ad,-L, Ad.-XL Size________
Total Enclosed ________
Check or money order payable to:
Iron Eagle/Safe, Inc.
SEMINAR REGISTRATION
Mail this registration form and dinner form if
attending with check or money order made
out to Iron Eagle/ Safe, Inc. PO BOX 2321
Wayne, NJ 07474 postmarked by June 1,
2005.
For further info contact:
Master Mike D’Aloia (201) 320-4067
hapkido@optonline.net or
Master Sheryl Glidden (207) 831-1885
jungki2@aol.com
Mail this registration form and dinner form if
attending with check or money order made
out to Iron Eagle/ Safe, Inc. PO BOX 2321
Wayne, NJ 07474 postmarked by June 1,
2005.
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 PUT A CHECK MARK NEXT TO
AND/OR FILL-IN APPROPRIATE AREAS.
AND/OR FILL-IN APPROPRIATE AREAS.
New York/New Jersey
Hapkido - Sat., June 25th- 12-4 p.m.
The Regency House Hotel
140 Rt. 23 North Pompton Plains, NJ
$100.00*
Jungki HKD Dinner in Honor of
Grandmaster Lim
Sat. Evening-June 25th- 6:30 p.m. at
Regency House
Open to All- $40.00
(Click Here for Dinner Form)
Hapkido - Sun., June 26th -12-4 p.m.
Iron Eagle Hapkido
26 Lakeside Ave.(Rear)
Pompton Lakes, NJ
$100.00*
Maine
Hapkido - Wed. June 29th 7-9 p.m.
William H. Rowe School
52 School Street
Yarmouth, Maine
$60.00*
New Hampshire
Kuhapdo(Sword)- Thurs. June 30th
7-9 p.m.
Atlantic Gymnastics
898 Central Ave. (Rear)
Dover, NH
$60.00*
Participants must bring their own
wooden sword.
Wooden swords only.
Connecticut
Hapkido -Fri., July 1st - 6- 9 p.m.
Holiday Inn Select
700 Main St.
Stamford, CT
75.00*
Massachusetts
Hapkido-Sat. July 2nd -12-4 p.m.
Hilton Garden Inn
800 Columbus Ave.
Springfield, Mass.
$100.00*
*($20.00 extra charge per seminar for
same day registration or
registrations received after 6/1/05)
No refunds will be issued. Checks
will not be accepted day(s) of
seminars.- Cash only.
Hapkido - Sat., June 25th- 12-4 p.m.
The Regency House Hotel
140 Rt. 23 North Pompton Plains, NJ
$100.00*
Jungki HKD Dinner in Honor of
Grandmaster Lim
Sat. Evening-June 25th- 6:30 p.m. at
Regency House
Open to All- $40.00
(Click Here for Dinner Form)
Hapkido - Sun., June 26th -12-4 p.m.
Iron Eagle Hapkido
26 Lakeside Ave.(Rear)
Pompton Lakes, NJ
$100.00*
Maine
Hapkido - Wed. June 29th 7-9 p.m.
William H. Rowe School
52 School Street
Yarmouth, Maine
$60.00*
New Hampshire
Kuhapdo(Sword)- Thurs. June 30th
7-9 p.m.
Atlantic Gymnastics
898 Central Ave. (Rear)
Dover, NH
$60.00*
Participants must bring their own
wooden sword.
Wooden swords only.
Connecticut
Hapkido -Fri., July 1st - 6- 9 p.m.
Holiday Inn Select
700 Main St.
Stamford, CT
75.00*
Massachusetts
Hapkido-Sat. July 2nd -12-4 p.m.
Hilton Garden Inn
800 Columbus Ave.
Springfield, Mass.
$100.00*
*($20.00 extra charge per seminar for
same day registration or
registrations received after 6/1/05)
No refunds will be issued. Checks
will not be accepted day(s) of
seminars.- Cash only.
