West’s Hapkido Academy Proudly Presents

J.R. West’s
Weapons Seminar and

Dr. He Young Kimm’s Yudo Seminar

291 HWY. 51, E-10
RIDGELAND , MS   39157
(601) 856-8487  

 August 1 & 2  2008

GM West’s Weapons Class - Fri.  6:30 P.M. - 9:00 p.m.       

Dr. Kimm’s Yudo Class - Sat.  1:00 P.M. – 5:00 p.m.

FEE for one or both days: $50 cash only at the door

[[  OPEN TO ALL BELTS - AGE 15 AND ABOVE   [[

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REGISTRATION FORM

NAME ________________________________________ PHONE  (______)_____________________

 DATE OF BIRTH______________________________________

 HOME ADDRESS ________________________________________________________________

CITY ___________________________ STATE ______________

 ZIP______________________________________

 RANK ____________  STYLE ____________________

INSTRUCTOR ____________________________________

 SCHOOL NAME _____________________________________________________________

 SCHOOL ADDRESS __________________________________________________________

  CITY __________________________________   STATE ________  ZIP _________________

 ORGANIZATIONAL AFFILIATION

 ________________________________________________________________

RELEASE:   For and in consideration of the use and membership of West's Hapkido Academy, Inc. facilities and other good and valuable considerations allowed by West's Hapkido Academy, Inc., I do hereby for myself, my heirs, executors, administrators, personal representative and/or assigns fully and forever remise, West's Hapkido Academy, Inc. and all other persons, firms, or corporations from any and all claim or claims, demands, injuries, damages, actions, causes of action, suit or suits or anything whatsoever resulting or to result to me by reason of any accident or injury that may occur during my voluntary use of said facilities.

          I do covenant with each and all parties released that I will hold them forever harmless and indemnify them and each of them from any and all claim or claims hereafter presented by any persons, firm, or corporation. I hereby authorize any and all photographs taken at this event to be used in any manner by the USKMAF or West’s HapKiDo Academy Inc.

 NAME_________________________________________ DATE____________________________

 PARENT/GUARDIAN SIGNATURE_________________________________________________

          (IF UNDER 18 YEARS OF AGE)