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Grandmaster Lim, Hyun Soo Hapkido & Kuhapdo Seminars 2005
Assumption of Risk Agreement, Release and Consent
Read Carefully Before Signing

Name: ______________________________Email:_____________Phone #:___________

Address:________________________________ City, State, Zip_________________

Date of Birth:___________ Style(s): __________________________Rank(s):_________

Any physical disabilities?  Yes______  No______ (If yes, list here)_______________

_______________________________________________________________________


The undersigned, _______________________________(fill-in your first and last name)assumes all
responsibility and risk for any and all of damages, injuries, or losses that the undersigned may sustain
or incur while, attending, participating in exercises/techniques or using the training equipment or
facilities,  and traveling to and from the Hapkido and/or Kuhapdo (sword) seminars. I, the undersigned
hereby releases, discharges, and waives  all claims, demands, rights of causes of action, present or
future, whether known, anticipated or unanticipated, and resulting from or arising out of, or incident to
my (the undersigned and participant) use (or intended use) of  the techniques taught at this seminar(s)
against title sponsors, promoters, organizers, operators, hosts, schools, owners, officers, directors,
employees,  black belts, instructors, masters, students, other participants, agents, affiliates,
Grandmaster Lim, the Jungki Kwan, Grandmaster Lim's Korea Jungki Hapkido & Kuhapdo Association,
Iron Eagle Hapkido & Karate Inc., Safe, Inc., Master Michael D’Aloia, and Master Sheryl Glidden.
I understand that Hapkido & Kuhapdo are physical activities that require the participant/undersigned to
be in good physical health. Al participants should consult a health care professional before
undertaking any physical activity.  
I understand that martial arts training is dangerous.
My participation in this seminar(s) is voluntary.  
Furthermore, I understand that my participation in this seminar will automatically authorize the
organizers  permission to use any photographs or video taken during the seminar for personal or
public usage such as promotion, articles, show, and advertising without additional consent and without
compensation at this time or any other time. I also understand that no videotaping will be allowed
during this seminar.  
I understand that no refunds will be issued.

I have read and understand and sign the foregoing assumption of risk agreement, and release and
consent.


Participant’s Signature_______________________________________________

Participant's Name:(Please print.)_______________________________________

Parent/Guardian Signature if Participant is a Minor__________________________
Parent/Guardian Name (Please print.)_____________________________________         
NJ-HKD - Sat. June 25th       $100.00   _____

NJ-HKD - Sun. June 26th      $100.00   _____

Dinner -   Sat. June 25th        $40.00   _____
Must fill-out dinner form.
CLICK HERE FOR FORM.  

ME- HKD-  Wed. June 29th    $60.00    _____

NH- KHD-  Thurs. June 30th  $60.00    _____

CT-HKD -   Fri. July 1st          $75.00    _____

MA-HKD     Sat. July 2nd        $100.00  _____

Yes, I would like to have to
pre-order a video or dvd.
It will be available for pick-up
at seminar.

The 3 HKD videos/dvds are
the requirements for
White to Black Belt in
Jungki Hapkido.
(Please read
WARNING
prior to ordering videos/dvds.)

Orthodox Hapkido Vol. 1         $50.00______
White/Yellow Belt Tech.
____DVD  _____Video

Orthodox Hapkido Vol. 2
Blue/Red Belt Tech.                $50.00______
____DVD  _____Video

Orthodox Hapkido Vol. 3
Purple Belt Tech.                    $50.00______
____DVD  _____Video

Orthodox Kuhapdo (Sword)
____DVD  _____Video           $50.00______

Grandmaster Lim
Seminar T-Shirts

1 for $12.00                            $12.00______
Size (Adult-M, Ad,-L, Ad.-XL    Size________

2 for $20.00                            $20.00______
Size (Adult-M, Ad,-L, Ad.-XL    Size________

Total Enclosed                             ________

Check or money order payable to:
Iron Eagle/Safe, Inc.
SEMINAR REGISTRATION
Mail
this registration form and dinner form if
attending with check or money order made
out to Iron Eagle/ Safe, Inc. PO BOX 2321
Wayne, NJ  07474
postmarked by June 1,
2005.
For further info contact:
Master Mike D’Aloia (201) 320-4067
hapkido@optonline.net  or
Master Sheryl  Glidden (207) 831-1885
jungki2@aol.com
PLEASE PUT A CHECK MARK NEXT TO
AND/OR FILL-IN  APPROPRIATE AREAS.
New York/New Jersey

Hapkido
- Sat.,  June 25th- 12-4 p.m.
The Regency House Hotel  
140 Rt. 23 North Pompton Plains, NJ
$100.00*

Jungki HKD Dinner in Honor of
Grandmaster Lim
Sat. Evening-June 25th- 6:30 p.m. at
Regency House
Open to All- $40.00
(Click Here for Dinner Form)

Hapkido - Sun., June 26th -12-4 p.m.
Iron Eagle Hapkido
26 Lakeside Ave.(Rear)
Pompton Lakes, NJ
$100.00*

Maine

Hapkido
- Wed. June 29th  7-9 p.m.
William H. Rowe School
52 School Street
Yarmouth, Maine
$60.00*

New Hampshire

Kuhapdo(Sword)
- Thurs. June 30th
7-9 p.m.
Atlantic Gymnastics
898 Central Ave. (Rear)
Dover, NH
$60.00*
Participants must bring their own
wooden sword.
Wooden swords only.

Connecticut

Hapkido
-Fri.,  July 1st - 6- 9 p.m.
Holiday Inn Select
700 Main St.
Stamford, CT
75.00*

Massachusetts

Hapkido-Sat. July 2nd -12-4 p.m.
Hilton Garden Inn
800 Columbus Ave.
Springfield, Mass.
$100.00*

*($20.00 extra charge per seminar for
same day registration or
registrations received after 6/1/05)
No refunds will be issued. Checks
will not be accepted day(s) of
seminars.- Cash only.