JEET KUNE DO CLINIC WITH PROFESSOR GARY DILL Thurs. May 24th 6:00-8:00pm

NAME__________________________________________D.O.B.__________________

ADDRESS_____________________________CITY__________________ST_____ZIP_____________

PHONE#_(______)___________________________Email_____________________________

RANK______________ SCHOOL NAME_______________________________

INSTRUCTOR_______________________MARTIAL ART(S)_________________________________

MAY 24th  6:00pm -8:00pm ROYAL DRAGON MARTIAL ARTS 741 W. Lumsden Rd. Brandon, Fla. 33511 813-654-5425

REGISTER IN ADVANCE $35.00    AT THE DOOR  $45:00   $____ Total Enclosed  CHECKS PAYABLE TO "Royal Dragon"
  * Dress Code is: Informal Training Attire or Martial Arts Uniform  
Final deadline for pre- registration price  May23rd  * NO REFUNDS   

Injury & Loss Waiver
I understand that participating in a martial arts seminar carries risk of injury. I accept these and all risks for personal injury or any other liabilities. I agree not to hold the seminar sponsors, participants, or instructors responsible for personal injury or for any losses or damage prior, during or after this martial arts seminar. I understand that there are no cash refunds under any circumstances including non-attendance or non-participation. The undersigned has read and voluntarily agrees to all of the above stated, and releases all rights to hold responsible any  persons involved with the promotion, or operation of this martial arts seminar.

PRINT NAME__________________________  SIGN NAME_____________________________

LEGAL GUARDIAN (for minors)_______________________________ DATE________________