Form

Full Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

- Area Code Phone Number

Cell Phone

- Area Code Phone Number

Birth Date*

Month Day Year

E-mail*

Gender*

Male Female

Parent's Name (if Minor)

Camp Subjects*

Other Subjects of Interest

My OMAC membership is paid up to date

Yes

Full or Part Time Attendee*

Full Time Part Time

For Instructor Discount: What class are you teaching at camp

Overnight Accomodations*

Stay at Dojang Stay at Hotel Stay at Home/Friends

T-Shirt Size (Before 1/14/12)

Present for meals*

NONE Saturday Breakfast Saturday Lunch Saturday Dinner Sunday Breakfast

I hereby submit my application to the Martial Arts Programs developed by Oriental Martial Arts College. I agree to waive against any person connected with any and all programs offered by Oriental Martial Arts College for injuries I may sustain and likewise assume full responsibility for all my actions in connection with all said programs of Oriental Martial Arts College. I understand there are rules and regulations associated with the programs and I will abide by said rules and regulations. I agree that I will not teach and/or alter the techniques and system presented at this seminar without going through the proper certification process and having a written consent from the Oriental Martial Arts College¹s masters committee of Oriental Martial Arts College. I also understand that any pictures and video tapes of me participating in said programs may be used for publicity without any compensation.

Acceptance*

I ACCEPT I DO NOT ACCEPT

My Products*

Type the letters or numbers exactly as shown*

OMAC 2012 Winter Camp

Personal Information

Camp Information

Liability Waiver

Security