IMACUSA National Training Camp
Registration Form & Waiver
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Martial Arts Style
*
Current Rank
*
Your Instructor
*
Martial Arts School Name
*
Martial Arts School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camp T-Shirt (Included in All Access Registrations received prior to June 15)
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Youth M
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Admission, Tickets, and Merchandise
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National Training Camp (All Access)
Camp Admission Fee
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
National Training Camp (Child 8-11)
1/2 Day Admission (One Day)
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
National Training Camp (Child 8-11)
1/2 Day Admission (Two Days)
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
Spectator Fee (One Day)
One Day Admission (Camp)
$
10.00
Quantity
1
2
3
4
5
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7
8
9
10
Spectator Fee (All-Access)
Attendance to All 3 Days of Camp
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Camp T-Shirt
$
30.00
Small
Medium
Large
X-Large
XX-Large
XXX-Large
HOF T-Shirt
$
30.00
Small
Medium
Large
X-Large
XX-Large
XXX-Large
IMAC T-Shirt
$
30.00
Small
Medium
Large
X-Large
XX-Large
XXX-Large
IMAC Polo
$
45.00
Small
Medium
Large
X-Large
XX-Large
XXX-Large
HOF Polo
$
45.00
Small
Medium
Large
X-Large
XX-Large
XXX-Large
CMAC Polo (Christian Martial Arts Council)
$
45.00
Small
Medium
Large
X-Large
XX-Large
XXX-Large
International Rank Registry
Register your Black Belt Rank
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
International Instructor Certificate
!st Dan through 4th Dan
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
International Master Instructor Certificate
5th Dan through 7th Dan
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
International Grandmaster Certificate
8th Dan or Higher
$
175.00
Quantity
1
2
3
4
5
6
7
8
9
10
International Sokeship Certificate
Founder, 10th Dan
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
WAIVER & RELEASE
I, the below-signed individual, voluntarily submit my application for training with the International Martial Arts Council of America (IMAC) and hereby declare that, to the best of my knowledge and ability, the information on this application is true and factual. Section I.I, the undersigned, requests the privilege of admission to the course organized by The International Martial Arts Council of America, Inc. (IMAC) and the United States Martial Arts Hall of Fame (USMAHOF) and given at the above-mentioned place and time. I understand that the classes taught in this seminar are martial arts-oriented, involving strenuous exercise and physical contact. I understand that martial arts and related defensive tactics are inherently dangerous, and I could face severe injury or death from participation in this event. I further understand that neither IMAC, USMAHOF, nor the organizers of this seminar offer any insurance or guarantees of any sort, nor subscribe to any insurance against illness or injuries to the course participants or damage to their property. In consideration of the privilege of being admitted to participate in the course, of receiving the provided instruction, and of using the host organization’s installations for the duration of the seminar and/or banquet activities, I hereby declare that I will personally assume all responsibility concerning any illness or injury that I may incur or that may be inflicted on me by others during the course, be it on or off the premises, before, after, during or between sessions or at the banquet. I hereby hold immune and release IMAC,USMAHOF, John Terry, its directors, employees, agents, and representatives, and DoubleTree by Hilton Tulsa Downtown (Tulsa, OK) from all responsibility, accountability, and any reparations concerning personal injuries, lawsuits, damages, losses of any nature whatsoever, in law and equity, relative to the activities mentioned above. I hereby agree and engage, in the name of my heirs and beneficiaries, never to pursue, legally or in equity IMAC, USMAHOF, John Terry, employees, agents, or representatives, or the DoubleTree by Hilton Tulsa Downtown (Tulsa, OK) in relation to such illnesses, injuries, lawsuits, damages, responsibilities, accountabilities, reparations, or losses. Your signature below also shall act as an image release allowing photos or videos taken to be used in promotional material.
I attest I have read and consent to this Waiver & Release
*
YES
Signature and Attestation
*
Signature of Parent or Guardian (if Participant is Under 18 Years of Age)
Relation to Camp Participant
Payment Methods
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