AKAYAMA RYU JUJUTSU SUMMER CAMP

JULY 12th & 13th 2008 

NEW ORLEANS, LA.

Hosted by Mark Burton Sensei and Akayama Ryu Jujutsu:

Dates & Times:                                                                   Cost:     

Saturday    9:00 a.m. till 4:00 p.m.                                        COST: $75.00 if paid by June 20, 2008. $95.00 if paid after.

Sunday      9:00 a.m. till 12:00 p.m.      

Lodging:

 All events related to the summer camp are to be announced. 

Contact:

            For more information, please contact Mark Barlow at akayama_ryu@yahoo.com or (251)979-6019.

REGISTRATION AND LIABILITY RELEASE

PLEASE PRINT CLEARLY

__________________________________________________         _________________________________________________

PRINT NAME                                                                                         PHONE AND/OR EMAIL

________________________________________________________________________________________________________

ADDRESS

___________________________________________________         _________________________________________________

STYLE                                                 RANK                                          DOJO                                                       INSTRUCTOR

I release all members, guests, and staff of Akayama Ryu Jujutsu, Mark Burton Sensei and any and

all participants of the Akayama Ryu Jujutsu Camps from any and all liability in the event of loss,

injury, or death before, during and after the Akayama Ryu Jujutsu Summer Camp.

__________________________________________________            _________________________________________________

Signature                                                                                                 Signature of Parent of Guardian if under 18

Mail To:                                                                                                       

Gulf Coast Martial Arts                                                           Make checks and money orders payable to:

PO Box 279                                                                                 GULF COAST MARTIAL ARTS

Bon Secour, Al. 36511