MARTIN WHEELER "Defining Moment Masterclass" SEMINAR REGISTRATION FORM
You're almost done! Sign the waiver below then make your payment.
WAIVER AND RELEASE OF CLAIMS
I (name and personal information listed in the spaces provided below), also known as "Releasor", do hereby apply to participate in the martial arts program MARTIN WHEELER "Defining Moment Masterclass" seminar in Sarasota, FL, provided by Tampa Systema.
I do hereby represent that I am 18 years of age or older, that I am in good physical health and free from any disabling physical conditions, and further acknowledge that TAMPA SYSTEMA, its proprietors, and its instructors are relying upon these representations to allow my participation in this Program. I am aware that any martial arts training, including this Program, inherently carries the risk of great bodily injury or loss of life.
I do hereby voluntarily, and with full knowledge of these risks, agree to participate in this Program.
In consideration for the opportunity to participate in the Program, I do hereby release TAMPA SYSTEMA, its proprietors, instructors, agents, employees, servants, successors and assigns, and other participants in the Program (the "Releasees") from responsibility or liability for any loss, injury or damage, however caused, and do hereby waive, indemnify, remise, release and forever discharge the Releasees for any loss, injury or damage, including loss of life, that I may suffer as a result of my participation in the Program. In the event that I (or my parent or guardian) am unable to do so, I do hereby grant TAMPA SYSTEMA, its proprietors, instructors, employees, servants or agents, permission to seek out any necessary medical assistance that they deem I may require as a result of participating in the Program, although I understand there is no obligation upon them to do so.
I do hereby waive and forever discharge TAMPA SYSTEMA, from any liability resulting from recording my likeness or voice during the Program and further agree that TAMPA SYSTEMA may use such recordings of my likeness and likeness of voice in audio, visual, audiovisual, or printed materials for any private or commercial purpose.
This Waiver and Release and all acknowledgements, agreements and representations contained herein shall by binding upon my family, heirs, successors and assigns.
This is the last step! Click the MAKE PAYMENT button to navigate to the payment page.
o All prices are quoted in US dollars
o It is the participant's responsibility to ensure that the payment deadline is met
o Please advise of any change in your contact information
o CREDIT CARD - UNAVAILABLE AT THIS TIME.
o PAYPAL (allows check, credit card, or PayPal account) - Use email@example.com
NOTE - a 4% transaction fee will be added.
o CHECKS - Please make payable to "Adalberto Gonzalez" and call, text, or mail Kenny for the mailing address.
* All registration and payments must be received by the indicated deadlines to be valid. (See the seminar information page.)
Your registration is not complete until payment has been received and funds have cleared.
If you're paying by check or money order, there is no need to go through the Make Payment process - simply mail your payment as outlined above. However, waiver and registration forms MUST be completed.