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2009 National Training Camp & Defensive Tactics Certification Registration Form |
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National Training Camp $125 (Pre-register by July 1) $150 (Registration After July 1) |
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National Kid’s Camp $100 (Pre-register by July 1) $125 (Registration After July 1) |
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Defensive Tactics Course $175 (Pre-register by July 1) $200 (Registration After July 1)
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Name
Phone
Address
Age
Sex
Personal Information
School / Training Information
School Name
Current Rank
School Address
Instructor
Style
IMAC Member
Yes
No
Number of Years You Have Trained in the Martial Arts
Other Training / Experience
Defensive Tactics Certification
Law Enforcement Agency Represented
Address
Phone
Supervisor
Certification Certificate Required
Yes
No
Current Law Enforcement Rank
Attestation
By signature below, I hereby register to participate in the 2009 National Training Camp and/or Defensive Tactics Certification Course. I understand any training in the martial arts is potentially risky, and hereby release the International Martial Arts Council, United States Martial Arts Hall of Fame, Combative Defense, and the staff, volunteers and instructors who will be teaching from any liability should I become injured. I acknowledge I am physically capable of participating in this camp and do so of my own free will.
Signature
Date Signed
Parent Signature (If Participant is Under Age 18)
Date Signed
Print and Return Form with Payment To:
International Martial Arts Council of America · 2914 North College, Suite 3 · Fayetteville AR 72703 · 479-582-5425
www.imacusa.com www.unitedstatesmartialartshalloffame.com
Payment By:
Check
Money Order
VISA / Mastercard
American Express
Discover Card
Credit Card #
Expiration Date
CSV #
CSV Number is the 3 digit number on the back of your VISA or Mastercard, or the 4 digit number on the front of your AMEX
Make checks payable to: International Martial Arts Council