S.R.M.A.T.- Spirit Rising Martial Arts Tour

S.R.M.A.T.  /   Membership Application            S.R.M.A.T.- I.D. # :854111-___________

FIRST NAME:_________________    MIDDLE INT:_____    LAST NAME:___________________

Address:_______________________________   City:_____________  State:_____   Zip:____

AGE: ___  PHONE # : ( ___ ) ____ - __________   E-Mail Address:________________________

DATE APPLING FOR BOOT CAMP MEMBERSHIP :   ____ / ____ / ____    

SUMMER  Boot Camp Event

(   ) MALE     (   ) FEMALE     HEIGHT: = ____ FEET      ____INCHES     WEIG HT: =_____ Lbs

I WILL ATTEND THIS YEAR, IN THE FOLLOWING - AGE BRACKET BELOW

(  ) 4 - 7,  (   ) 8,  (   ) 9,  (   ) 10,  (   ) 11,  (   ) 12,  (   ) 13,  (   ) 14,  (   ) 15,  (   ) 16,  (   ) 17,  (   ) Adt.

I WILL PARTICIPATE THIS YEAR EVENTS      ___ MARTIAL ARTS BOOT CAMP 

MY MEDICAL INFORMATION

(   ) I HAVE NO MEDICAL PROBLEMS

IF NOT CHECKED ABOVE, PLEASE INDICATE ANY MEDICAL PROBLEMS BELOW:

(   ) HEART MURMUR        (   ) CONCUSSION          (   ) SEIZURES                        

(   ) BONE FRACTURE       (   ) DIABETES                 (   ) ASTHMA                         

(   ) EYE INJURY                 (   ) BONE BRUISING      (   ) HYPERTENSION      

(   ) BLOOD 

(   ) OTHER :_______________________________________________________________

BY SIGNING BELOW, I AGREE WITH AND STATE THAT, I HAVE READ THE REGISTRATION PROCEDURE, LISTED ON THIS U.S.M.A.N.com ON-LINE S.R.M.A.T. MEMBERSHIP FORM AND I UNDERSTAND THAT THE ACCURACY, LEGIBILITY AND TIMELY RETURN OF THIS APPLICATION IS IMPERATIVE FOR MY PARTICIPATION IN SUMMER OR WINTER EVENTS.

REMEMBER TO SIGN BELOW AND MAIL IT IN !!

I, hereby for myself, my executor(s) and heirs, forever and always agree to save and hold harmless the U.S.M.A.N..com, S.R.M.A.T., N.K.KU., W.O.C., N.M.A.L., M.A.C., T.U.M.A.A., M.A.A.D., F.E.I., it's Organization(s), officers, referees, judges, volunteers, members, event directors, promoters, competitors, facility owners, their respective agents, successors or anyone else involved in these events. For any injury and/or liability, that I may susstain, to include my way of travel to or travel to or from the Martial Arts Events. My direct involvement participating in this event. I willingly, with full understanding, that I agree to alow, without compensation, the unrestricted use of any Website photographs, films or videotape of myself.

EMERGENCY # : (  ____  )   ____  -  ______    EMERGENCY PERSON : __________________

CAMPER SIGNATURE : _______________________________          DATE : __________

PARENT OR GUARDIAN SIGNATURE : ___________________________      DATE : ________

                                                                           ( If Camper Is under 18yr Of Age )

                                  SUMMER BOOT CAMP MEMBERSHIP = $40

CHECK or MONEY ORDER # ___________________     TOTAL AMOUNT = $____________

                             RETURN TO :     (  S.R.M.A.T. )

                            c/o S.R.M.A.T.  MEMBERSHIPS

              P.O. BOX 18393       GARDEN CITY, GA.   31408

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Form :RF111458-99-03-07-11-m.a.c.-membership-form-online

*** WARNING ***

This form can be printed and mailed in for Membership, but is placed on the website as an online view of the Spirit Rising Martial Arts  Tour with the Grandmasters, Campers Form, for all Camper to see what is on the Official Boot Camp form that can be ordered and direct mailed to you

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Summer  

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