National Training Camp Registration

IMACUSA National Training Camp

Registration and Liability Waiver

To register for our National Training Camp, please complete the Camp Registration and Liability Waiver Form below in its entirety. When you submit this form, you will be redirected to our Online Store where you can remit your Camp Registration Fee and also purchase Camp T-Shirts, Patches, Polos, and Certificates. You can securely remit your payment using our Paypal Merchant account.

If you prefer to send in a paper registration form, click HERE.

Name*

Age*

Address*

City*

State*

Zip*

Email*

Style*

Highest Rank*

Your Instructor*

Your School*

School Address*

City*

State*

Zip*

Waiver & Release Notice*

Waiver

I, the below-signed individual, voluntarily submit my application for training with the International Martial Arts Council of America (IMAC) and hereby declare that, to the best of my knowledge and ability, the information on this application is true and factual.

Section I.

I, the undersigned, request the privilege of admission to the course organized by The International Martial Arts Council of America, Inc. (IMAC) and the United States Martial Arts Hall of Fame (USMAHOF) and given at the above-mentioned place and time. I understand that the classes taught in this seminar are martial arts-oriented involving strenuous exercise and physical contact. I understand that martial arts and related defensive tactics are inherently dangerous and I could face severe injury or death from participation in this event. I further understand that neither IMAC, USMAHOF, nor the organizers of this seminar offer any insurance or guarantees of any sort, nor subscribe to any insurance against injuries to the course participants or damage to their property. In consideration of the privilege of being admitted to participate in the course, of receiving the provided instruction, and of using the host organization’s installations for the duration of the seminar, I hereby declare that I will personally assume all responsibility concerning any injury that I may incur or that may be inflicted on me by others during the course, be it on or off the premises, before, after, during or between sessions. I hereby hold immune and release IMAC, USMAHOF, John Terry, its directors, employees, agents, and representatives, and the Houston Marriott Westchase from all responsibility, accountability, and any reparations concerning personal injuries, lawsuits, damages, losses of any nature whatsoever, in law and equity, relative to the activities mentioned above. I hereby agree and engage, in the name of my heirs and beneficiaries, never to pursue, legally or in equity IMAC, USMAHOF, John Terry, employees, agents or representatives or the Houston Marriott Westchase in relation to such injuries, lawsuits, damages, responsibilities, accountabilities, reparations or losses. Your signature below also shall act as an image release allowing photos taken to be used in promotional material.

TO ATTEST TO THIS, I have signed this document and declare that I have read it and understand it.

I agree

ATTESTATION: I have read this waiver & release form and understand it.*

YES
NO

Participant Digital Signature*

Participant Digital Signature (Repeat)*

Parent or Guardian Signature (if Participant is under 18 years of age)

Relationship to Participant

Parent or Guardian Signature (if Participant is under 18 years of age) REPEAT

Relationship to Participant