The EDGE Ultimate Martial Arts Presents

The 2X Lumpinee & World Champion

Kansak

Saturday, November 15, 2021

11:00 AM 2:00 PM

 

at The EDGE Ultimate Martial Arts

Route 209, Monroe Plaza

Brodheadsville, PA

 

Seminar Fee: $100.00

Must Register by November 1st

 

All MUST Pre-Register -Space Limited

NO Registrations at the door - NO Spectators - NO Exceptions

 

 

Name: ________________________ Age: ___________

 

Address: _________________________ City: ________________

 

State: ________ Zip: _________ Telephone: ______ - _____ - _______

 

 

*NON-REFUNDABLE Amount Paid: $______________

 

 

NOTE: Mail Payment and registration form to:

The EDGE Ultimate Martial Arts

101 Route 46 West, 2nd Floor

Saddle Brook, NJ 07663

Or...E-mail to [email protected] with credit card information to secure your spot.

 

Or... call The EDGE at 201-703-1222 and register by phone

Liability Waiver

We, the seminar participant and guarantor if applicable on behalf of ourselves, members of our family, our heirs, executors, administrators and assigns, hereby forever release, discharge and hold harmless, The EDGE Ultimate Martial Arts, Richard Raciti, representatives and agents for any injury, loss, or damage to my person or property howsoever caused, arising out of or in connection with my taking part in martial arts classes and activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of The EDGE Ultimate Martial Arts, Richard Raciti, Representatives, or agents. NOTE: Participants must supply their own protective equipment. *After registering for the seminar your space is reserved therefore no refunds will be given for those who do not attend the seminar.

 

______________________ ______________________________

Signature Parent/Guardian if under 18 years.