Lee Wedlake Kenpo Seminar Sign-up Form

March 19, 2011

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Martial arts can be hazardous. Your signature below indicates that you knowingly accept to train at your own risk. All registrants must sign this waiver. If you are under 18 years of age, your parent or guardian must sign this waiver.

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Names(print)of those with whom you are registering>

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Please check the sessions you will be attending.
____Session 1: "Kid's seminar"
Time: 11:00 AM- 12:00 PM
$19.00 pre-paid by March 10, 2011 or $29.00 after March 10 or at door.

____Session 2: Family groupings, ""
Time: 1:00 AM - 2:30 PM
$49 pre-paid by March 10, 2011, $59 after March 10 or at door.

____Session 3: "Kenpo self defense"
Time - 3:00AM - 4:30PM
$49 pre-paid by March 10, 2011, $59 after March 10 or at door.

Total enclosed:_____________

Please make checks payable to: Frank Shekosky.
Send to:
Cromwell Martial Arts
871F Newfield Street
Middletown, CT 06457