Participant Information

* Name

* Date of Birth

* Street Address

* City

* State

* Zip Code

* Phone Number

* School

* Rank

* Email

Training fees include: Instruction and a certificate of completion.
Open to all ability levels, ages 16 and above.
We recommend white Martial Arts attire, with athletic shoes for this event.
Make checks or money orders payable to D. Piller. (Fees are non-refundable)
Mail payment and registration to: D. Piller 19722 E. Villanova Pl Aurora, CO 80013
Camp will be held at Crown Plaza 450 Harbor Blvd., Ventura, CA 93001-2708

I hereby voluntarily submit my application for attendance and participation in said WHA Summer Training Camp 2008 and hereby assume all responsibilities for any and all damages, injuries or losses I may sustain or incur while attending, participating and traveling to and from said activity. I hereby release and waive all claims against the sponsors, promoters, organizers, operators hosts, instructors, associations, school, owners, officers, directors, employees and other participants connected with said WHA Summer Training Camp 2008 individually or otherwise. I also understand further that I shall strictly obey instructors and observe safety rules. I further agree that any pictures and video taping of me in connection with said activity can be used for publication, promotion, articles, shows, and advertisement without additional consent and without compensation at this time or any other time. I understand that registration fees are non-refundable.

* Signature (If under 18 must be signed by legal guardian)

* Date