Printable Workshop Enrollment Form

Pre-Registration Required for most Workshops

(Please Print This Information Legibly)

Participants Information Name __________________________________________ Age _______ Sex _______ Address _______________________________________________________________ City _____________________________________ State _______ Zip _____________ Telephone (     )                          ______  E-mail _______________________________

Workshops:

[ ]   Dan “The Beast” Severn ”Mixed Martial Arts Workshop” 03/26/2006
Advance Registration
Attending One Seminar: $50.00
Attending Both Seminars $85.00

At the door Registration
Attending One Seminar: $65.00
Attending Both Seminars: $115.00

[ ] Magic Workshop-Robert Rasner $20 03/26/2006

[ ] Grand Master Sang Sup Kil Self Defense Training $55 03/25/2006

[ ] Master Yong Sup Kil Olympic Fighting $55 03/25/2006

[ ] Yoga by Dr Deepika Parekh $40 03/26/2006

[ ] Stick Dancing by Dr Deepika Parekh $5 03/26/2006

[ ] Jeet Kune Do session with Richard Bustillo $45 03/25/2006

[ ] Kali/Eskrima/Arnis session with Richard Bustillo $45 03/26/2006

[ ] Both sessionis with Richard Bustillo $60.

Waiver Clause/Hold Harmless Agreement

I, the undersigned, do hereby voluntarily submit my application for

registration in the said workshop held at the World Health fitness Wellness and Battle of Detroit Championships. I agree to waiver any and all claims against any persons or organizations connected with the World Health Fitness Wellness and Battle of Detroit Championships and or Commmunity Bridges it’s promoter for  any injuries I may sustain.  I likewise assume full responsibility for all my actions in connection with the said workshops.  I further agree that the promoter may use for publishing or promotion any pictures taken of me in connection with the said event without compensation at this or any other time hereafter.

If Participant Is Under 18 Years Old The Parent/Guardian

Must Sign This Entry Form.

Signature: ___________________________________