Midwest Karate Convent

Midwest Karate Convention Registration Form

First name

Last name

Address

Phone

Dojo

Sensei

Emergecy Contact & Phone Number

Select an item ($)

Individual Registration Fee - $40.00

Family Registration Fee - $75.00

By checking this box, I am stating that I have read it in its entirety and fully understand that training at this event is a physical activity where injury and/or accidental death can occur. I indemnify and hold harmless the Sho Rei Shobu Kan Budo Organization, Lincoln Martial Arts Center, Brad Siebler Sensei, and/or staff and guest instructors from any and all liability or injury that may occur as a result of my participation. I also understand that no medical, health, or life insurance of any kind is implied or provided, and that I am fully responsible for any and all costs that may be incurred as a result of injury or illness due to my participation in this training, as the techniques are considered dangerous. I am also making testimony that I am of sound mind and body. I promise to never use what is taught to me at this seminar to harm another person unjustifiably, and I shall obey the rules and commands of the instructors at all times. By teaching these techniques, the instructors in no way acknowledge the competency level of any participant and are hereby held harmless from any and all vicarious liability.

Thanks for registering to our event. See you there!