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Master Steve Seo-Korean Martial Arts in MississippiKuk Sool Hapkido Seminar Registration form

Saturday May 14th 2011 and Sunday May 15th 2011

Name: Age if under 18:

Address: City:

State: Zip Code: Phone: _____________________________

Phone: E-Mail:

Style: Rank:

School Name: Instructor: __________________________________

I hereby make application to participate in the above mentioned Korean Martial Arts seminar, and upon acceptance, I recognize there is arisk of bodily injury or other personal loss for which I am totally responsible.I further affirm that I am in good health and I am aware that all activities including but not limited to physical training, stretching, and all otheractivities inherent to participation in the martial arts are entirely voluntary. I am aware that I can elect not to take part in any activity which Ifeel may involve some element of risk or discomfort to me.I agree to hold harmless and indemnify Steve Seo, the organization (World Kido Federation) and/or affiliated associations and all instructors,

members, and promoters of this seminar as well as Chris Holmes, Epic Martial Arts and authorized guests from liability for damages for anyinjuries, including but not limited to death and disability arising from any of the activities of the seminar. I also understand that any treatmentfor injuries that I may sustain will be of a first aid type only, given with my permission, and I fully understand that the provider may not be atrained medical person. I also authorize, by the present, the use of pictures or video images of myself that I have submitted or that shall betaken at the seminar for publicity or promotional purposes and I renounce any and all compensation in this respect.

_________________________________________________ _____________________Applicant's Signature Today's Date

FOR MINORS ONLY: As parent or guardian of the above named applicant, I request that the applicant be accepted and agree to holdharmless and indemnify, Steve Seo, Chris Holmes, the organization (World Kido Federation), Instructors, participants, Epic Martial Arts andauthorized guests, from all claims made by or on behalf of the applicant, in consideration of accepting him/her for entrance in this above

named seminar.

_____________________________________________ _____________________ Parent or guardian (if applicant is under 18 years of age) Today's Date

Beginner Kids Session $40.00 at the door Pre Register for $30.00Advanced Session I or II $60.00 at the door Pre Register for $50.00Advanced Session I and II (Both) $100.00 at the door Pre Register for $80.00Awards Banquet Pre Register Only Pre Register for $35.00

Total Amount Enclosed $___________

(Please circle one of the following if attending the Awards Banquet:Steak, Fish, or Chicken Parmesan.)

Pre Registration Fees must be post- marked no later than April 8th.

Please note: Instructors bringing ten or more students attend the seminar for free!!

All fees are payable by certified check or money order to:

Epic Martial Arts23 Firetower Rd.Jayess, MS 39641

Contact: Master Chris Holmes (601)-248-3222 epicmartialarts@hotmail.com

Seminar Location:Epic Martial Arts

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313 Richmond St.McComb, MS 39648