Lee Wedlake Kenpo Seminar Sign-up Form

March 9, 2008

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E-mail Address.............................................................................
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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: "Foot maneuvers"
Time: 11:00 AM- 12:00 PM
$25.00 pre-paid by March 1, or $35.00 after March 1 or at door.

____Session 2: Running the line, ""
Time: 1:00 AM - 2:30 PM
$49 pre-paid by March 1, 2008, $59 after March 1 or at door.

____Session 3: "fundamentals of instruction"
Time - 3:00AM - 4:30PM
$49 pre-paid by March 1, 2008, $59 after March 1 or at door.

Total enclosed:_____________

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