Camp Shotokan 2010

Online Registration

August 11 - 15, 2010
Register on-line TODAY - classes fill quickly!
Each person must fill out an individual application!

This is NOT an online GROUP registration form.
To enroll a group contact us for a group registation form at: amy.hung@AmericanJKA.com
Fax PDF to: 760.655.4326

Late Registration Begins July 21, 2010; Additional $40 Late Fee Will Automatically Be Added After 7/21/2010


Note: Fields must be filled in order for your registration to process correctly.
 Registration Process
Select your options below:
1 - Complete the camp attendee information.
2 - Select the "SUBMIT Form" button below.
Camp Attendance Options
NOTE: Late registration fee of $40
will be automatically added after 7/21/2010.

You can also fax your
registration information to:
760.655.4326

Select a Camp Option
NOTE: One Person Per Online Registration
Each Person Must Fill-out an Individual Application

Select one of the following 3 options,
select only one option:

1 - AJKA, CSKA, ASKA, WUKF Members

2 - Non-member Rates

3 - For Per Session Applicants Only:
How Many Sessions Will You Attend?
Per session: $40
4 sessions or more: $35 per session
Applicant's Name
 First name

Last name
Declare legal status:
Parent or Legal Guardians Name
NOTE: A minor must have a parent or legal guardian agree to the waiver and release from liability and assumption of risk to attend Camp Shotokan 2009.
 Skip this section if you're 18 or older:
Parent or legal guardians first name

Parent or legal guardians last name
Are you the parent or legal guardian (you must pick one)?
Applicant's Birthday
Applicants Age
Contact E-mail Address
Mailing Address
City
State/Province
Zip/Postal Code
Home Telephone - REQUIRED
(include area code)
Cell Phone
(include area code)
Rank or Dan Level
Organization
Dojo Name
Instructors Name
T-shirt Size
Payment Method
(you must pick one)

BILLING INFO
We accept VISA or MasterCard ONLY (Credit or Visa-Debit Cards ONLY):

Enter Credit or Debit Card
Account Number

Account Number

3 Digit Code From the Back of Your Credit Card:

 Card Verification - 3 Digit Code

What is a credit or debit verification number?
Credit or Debit Card Expiration Date (example: 05/09)
 Expiration Date (example: 05/09)
Name of Financial Institution
i.e. - Bank of America, Chase, FirstCard:
 Name of Financial Institution
Account Holder's Name:

First name

Last name
Billing Address
City
State/Province
Zip/Postal Code
Waiver and Release from Liability, Assumption of Risk,
and Enrollment Terms		 The undersigned understands and agrees that the class/course/camp for which he/she is registering for involves an inherent risk of accidental physical harm or injury and understands that this assumed risk may arise from, but not limited to, the instruction, explanation, practice, and training in the subject matter of the course. The undersigned, therefore, agrees that the risk of any such injury is assumed by him/her, and hereby relieves and agrees to hold harmless, on account of physical and/or mental injury sustained by him/her, the American JKA Karate Association-International, aka AJKAI, its owners, officials, instructors, other participants, sponsors, agents, and/or employees from any and all claims, demands, rights and causes of action whatsoever (of all listed individuals or businesses), arising from and by reason of his/her participation in said class/course/camp. The undersigned further states that he/she is in good health and physical condition and has medical insurance which covers his/her participation in this class/course/camp. Also, the undersigned agrees to allow, without compensation, the unrestricted use of any photographs, film, or video/DVD recorded material while enrolled at Camp Shotokan 2009.

Camp fees will be collected as stated above without credit or refund, and is non-transferable.

The undersigned further states that he/she has read this Waiver and Release from Liability, Assumption of Risk, and Camp Participation Terms, understands the contents thereof and has executed same of his/her own free will for him/herself and/or the camp attendee listed above.

You must acknowledge the terms.

First name

Last name
How did you
hear about us?
(required)
Comments
(optional)

Select class from above BEFORE pressing the "Submit Form" button!

Note: Fields must be filled in order for your registration to process correctly.

Return to American JKA Karate Association - International
Recommended Books and DVD's Perfect Form, Inc. Shotokan DVD's and Books

Contact Information
Fax: 760.655.4326 • amy.hung@AmericanJKA.com

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