In order for us to better identify what you need from this seminar, please do answer the questions on this form. Other than your contact information, waiver and your planned days of attendance (w/fee summary) they are each optional, at your discretion. It will help us to better serve you:
These registration questions are asked simply for us to attempt to best provide what the attendees wish to encounter. They also, because of Drew University’s sponsorship, provide us with a way of offering a discount to those answering in a timely way.
Those who respond by May 10th will receive a discount of $30 per day and a total discount, if attending all 3 days, of $100. College and High School Students are eligible for further discounts, if they present a current student ID. (Please inquire about further discounts before May 10).
Please send the completed form, the completed waiver and your payment (checks only please) to:
Mr. Dayn DeRose, Head Coach, Drew U. Varsity Fencing c/o: 6 Sycamore Lane, Unit 6, Morristown, NJ, 07960
Checks should be payable to “Dayn DeRose-SMMA”
Drew University
Kawakami Ninjutsu Panel Discussion & Seminar
New Dates: June 26th, 27th & 28th
Seminar Participant’s Pre-Registration Form & Waiver
Please print this form, along with the waiver which you will find
HERE.
1. Name (& Title)___________________________________________
2. Address_____________________________________________________________-
3. A. Preferred Phone____________- B. Preferred E-Mail __________________________-
4. I am planning to attend; (1 day; $120/ 2 days; $220/ 3days; $300)
June 26th ______ June 27th_______ June 28th________ Total Enclosed:___________
5. Which Martial Arts do you practice? How long? (You may include rank as a reference) Do you teach?
______________________________________________________________________________
6. What was your reason (inspiration) for beginning Martial Arts Practice? Has it changed? If so, can you briefly describe your present motivation? Can you describe your “Orientation”, i.e., “Classical”, “Competitive”, “Self Defense” or any brief description you deem fit?
_______________________________________________________________________________________
_____________________________________________________________________________________
7. Who have been your teachers (role models)?
______________________________________________________________________________
______________________________________________________________________________
8. Is the “Ethnic History” of the Martial Art(s) you practice important to you?
______________________________________________________________________________________
_______________________________________________________________________________________
9. Are you a current University or High School Student?? Yes No
10. What, specifically, would you like to experience at this clinic?
South Mountain Martial Arts
91 Main Street, Madison New Jersey 07940-1849
(973) 822-1977
Ninjutsu Seminar
