AKAYAMA RYU JUJUTSU WINTER CAMP

January 14^th & 15^th 2012

Orange Beach, Alabama. 

Hosted by Gulf Coast Martial Arts and Akayama Ryu Jujutsu:

Dates & Times:                                                                   Cost:     

Saturday    9:00 a.m. till 4:00 p.m.                                        COST: $65.00 if paid by December 18th, 2011. $75.00 at the door.

Sunday      9:00 a.m. till 12:00 p.m.

Contact:

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

REGISTRATION AND LIABILITY RELEASE

PLEASE PRINT CLEARLY

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PRINT NAME                                                                                         PHONE AND/OR EMAIL

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ADDRESS

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STYLE                                                 RANK                                          DOJO                                                       INSTRUCTOR

I release all members, guests, and staff of Akayama Ryu Jujutsu, Mark Barlow 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 Camp.

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Signature                                                                                                 Signature of Parent of Guardian if under 18

A camp t-shirt is included with tuition if received before December 18th, 2011. Please indicate sizes below.

Mail To:                                                                                                       

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

PO Box 279                                                                             GULF COAST MARTIAL ARTS

Bon Secour, Al. 36511