Ka Muso Kai

6^th Annual Summer Seminar Registration Form

August 10^th to 12^th, 2012

Instructions:

Please fill out the below form and mail it to Chris Gilham at 9 Coachway Green, SW. Calgary, AB. T3H 1V9.

All fees Payable to 'Calgary Iaido Club':

Name:                                                                                                                                                 

Address:                                                                                                                                             

Town/City:                                                                                                                                         

Province/State, Country:                                                                                                                    

Postal/Zip Code:                                                                                                                                

Phone:                                                                                                                                                

In the section below please tell us if you are registering for particular sessions ($30 per session) or for all sessions ($120):

Total Cost: _____________

Payment Included (Please Circle):    Yes        No

Disclaimer/Waiver (IMPORTANT):

I, the undersigned applicant to the Ka Muso Kai Seminar understand that I am applying for instruction in kenjutsu, an activity that involve physical activity. I further understand that the Ka Muso Kai carries no insurance against injury to any of the participants in the seminar.

I hereby acknowledge that I am assuming the risk and responsibility for any and all injuries that I may suffer due to injury, suffered by me, or caused by third parties to me arising out of the practice of Kage Ryu, Niten Ichi Ryu, Jodo, or during the use of any of the facilities available. I further acknowledge that I am responsible for providing my own personal health, medical, dental and accident insurance coverage. I hereby release the Ka Muso Kai and all of its associated persons from liability for any injury or loss suffered by myself.

DATE_______ SIGNATURE ______________________________

PARENT/GUARDIAN (under 18)___________________________