Karate College 1988-2018
(Name) (Age) (Phone number)
(e-mail address for Confirmation and arrival instructions)
(Street address) (Apartment or P. O. Box number)
(City) (State) (Zip code)
NOTE: Regular fee, $249. If received before June 1, pay only $219 for instruction. All participants must complete the application form and sign the waiver.
________ Pay only $99 non-refundable deposit. The balance of $120 is due at
Check-in. Kids camp members ages 6-12 years pay a balance of only $100.
________ I am a member of a Black Belt Recruiter group of five or more participants.
Recruiter’s name__________________________(Must list all participants on one page with payments)
Lodging: For the best Karate College rates contact the RU conference center for lodging only at (540) 831-5800. E-mail firstname.lastname@example.org or mail to Summer Conference, P.O. Box 6911 RU, Radford VA 24142. Be sure to reserve rooms now! Or, stay off campus at the Camp Hotel: the Christiansburg Quality Inn (9 miles from the Radford Recreation Center on Interstate 81). Call 540-382- 2055 to reserve a room that sleeps 1-4 for only $59 per night! Ask for Karate College rates.
________ I missed the June 1, 2018, deadline. Enclosed is my $99 deposit. I will pay the balance of $165 at check-in.
Note: Confirmation letters will be e-mailed to all pre-registered campers during the first week of June. Please make all checks/money orders payable to: Karate College 2018. Mail applications and fees to: Karate College, P. O. Box 402, Christiansburg VA 24068. For more information, call (540) 381-2025.
I have had previous martial arts instruction, and I understand that practice in the Karate College 2018 (June 21-24) may be dangerous and that, by participating in this program, I may be seriously injured. I freely waive all rights to Aikia LLC, Dr. Jerry Beasley, the instructors, and staff of Karate College 2018, and to Radford Recreation Center. ______________(initials). I have accident and/or medical insurance to cover any injury that I might sustain;___________(initials) therefore, in return for admission to the camp, I forever give up any rights against Aikia, LLC, Dr. Jerry Beasley, Radford Recreation Center, Radford University, and Karate College 2018 promoters, instructors, and staff. My signature is proof of my intention and understanding of this policy.
(Signature of participant) (Age) (Date)
(Name of parent or legal guardian if participant is under age 18 years)
(Signature of parent or guardian) (Date)
Dr. Jerry Beasley
P.O. Box 402
Christiansburg, VA 24068
Karate College 1988-2018
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