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Kennedy's Martial Arts Academy *Only If Space Is Available for 1199 Biesterfield Road Both Days

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Kennedy's Martial Arts Academy *Only If Space Is Available for 1199 Biesterfield Road Both Days Kennedy’s Martial Arts Academy Presents nndd TThhee 22 MMiiiddwweesstt CCAAMMББOO//SSAAMMBBOO CCaammpp wwiiitthh IInnssttrruuccttoorrss GGrreegggg HHuummpphhrreeyyss,,, CCoorreeyy HHuummpphhrreeyyss,,, VVlllaaddiiisslllaavv KKoouullliiikkoovv,,, DDoouugg FFoouurrnneett aanndd LLaavveellllll MMaarrsshhaallllll The Midwest CAMƂO/SAMBO Camp will be held in Elk Grove Pre-Registration Village, Illinois at Kennedy’s Martial Arts Academy. Kennedy’s Martial Arts Academy is a Gold Medal level Before Oct 1, 2017 professional member club under the direction of Patrick Kennedy. Kennedy’s Martial Arts Academy has crash pads and a spring loaded floor. This incredible location will make Participant both days - $200 for a weekend of hard training punctuated with some Participant 1 day - $125 recreational and relaxing activities. Late Registration* Training Camp Location: - $250 Kennedy's Martial Arts Academy *Only if space is available for 1199 Biesterfield Road both days. Elk Grove Village, Illinois 60007 Phone: (847) 891-8731 Late Registration* - $175 www.TangSooDo.com *Only if space is available for one day. Seminar is limited to thirty students on a first come, first serve basis. Seminar fee covers all training. All meals are the responsibility of the participant. Participants must bring their own training clothes & Training Schedule**: protective gear. Males are required to wear cups and knee Saturday, October 14. Training Sessions: pads if wearing shorts. If you 10:00 am – 12:00 pm: Training Session 1 (Takedowns) do not have one you may 12:00 pm – 2:00 pm: Lunch/Free Time purchase one prior to the event. 2:00 pm – 4:00 pm: Training Session 2 (pins/submissions) NO VIDEO RECORDING IS 5:00 pm Dinner/Free Time ALLOWED! Sunday, October 15. Training Sessions: For more details contact Mr. 10:00 am – 12:00 pm: Training Session 1 (Throws) 12:00 pm – 2:00 pm: Lunch/Free Time Patrick Kennedy 2:00 pm – 4:00 pm: Training Session 2 (pins/submissions & QA) 847-891-8731 or via e-mail **Schedule Subject to Change at [email protected] Midwest CAMƂO/SAMBO Camp Registration: Please fill out this form and return to the address below WITH PAYMENT. Your space in the camp will not be reserved until payment is received. Those wishing to reserve a spot in the Midwest CAMƂO/SAMBO Camp can do so via credit card by calling Marie Kennedy at (847) 891-8731 and e-mailing us your application. We DO NOT arrange your hotel for you. But, we do have suggested hotels. Kennedy’s Martial Arts Academy 1199 Biesterfield Road Elk Grove Village, IL 60007 [ ] $200.00 USD – Includes two days of training (postmarked before Oct 1, 2017) [ ] $250.00 USD – Includes two days of training (postmarked after Oct 1, 2017) Participant’s Name: ____________________________________________________________ Address: _____________________________________________________________________ City: ________________________________________ State: _______Zip:________________ Home Phone: (______)____________________ Cell Phone: (_____)_____________________ Email: ________________________________________________________________________ Birth Date: ________________________ Sex: M / F EMERGENCY CONTACT INFO: Emergency Contact Name: ______________________________________________________ Relationship:__________________________________________________________________ Home Phone: (______)____________________ Cell Phone: (_____)_____________________ Any Medical Concerns (Asthma, Diabetes, etc.)? ____________________________________ Liability Waiver In consideration of my acceptance of entry, I do hereby for myself, my heirs, my executors, and administrators waive, release, and forever discharge any and all rights and claims for damages which I may have or which may occur to me against the SAMBO Fusion, Kennedy’s Martial Arts Academy, I.A.K.M.A., Inc., the State of Illinois, all instructors/coaches and members of the event, and against any participant for any and all damages which may be sustained by me in connection with my association with or entry in the above athletic event, or which may arise out of traveling to, participating in, and returning from this athletic event. I understand that SAMBO is a contact martial art/sport and I further understand all the rules and general information provided by the sponsor and I agree with them in their entirety. I hereby grant to Kennedy’s Martial Arts Academy the right to use photos and videos taken during school activities any such photos and videos may be used at such functions or activities, including but not limited to, classes, seminars, demonstrations, rank promotion testing, holiday parties, picnics, summer camps, etc. for publicity and/or promotional purposes. I waive any and all rights to such likeness, and will not be compensated in any manner for the use of such photos and videos. Participant’s Signature: __________________________________ Date: ___________ Parent/Guardian’s Signature: _____________________________ Date: ___________ Midwest CAMƂO/SAMBO Camp Instructors Doug Fournet is awarded the Gold medal at the Dutch Open in Netherlands. Doug Fournet. Baton Rouge, Louisiana Doug is a longtime Judoka & Sambist having competed on the US team for FILA worlds (Sambo and grappling), FIAS (Sambo), and the American Sambo Association's Team American Sambo (Sambo and Grappling). He is also a Battle of Brooklyn veteran, World Combat Games veteran (Sambo), and veteran of several mixed martial arts fights. Most recently Doug brought home gold and bronze medals at the Belgium Sambo Open in 2013 and gold from the 2010 British Sambo Open and 2011 Dutch Sambo Open. Doug also took 3rd place the FILA grappling worlds in Turkey. Doug currently coaches at UFC Gym in Baton Rouge. Gregg Humphreys (in blue) demonstrating a throw on Corey Humphreys (in red). Gregg Humphreys, Bettendorf, Iowa Gregg is a 5th degree black belt in Judo and long-time Sambist. Gregg has been taking teams to Russia, Ukraine and Belarus for training camps on a bi-annual basis since 1987. He is Sambo World Champion Igor Kurinnoy's North American Representative and editor of Igor's Sambo for Professionals series. Gregg was the Midwest Vice President of the American Sambo Association (ASA) and the Iowa AAU Representative for Freestyle Judo. He is also a Continental Coach under USA Judo. Gregg is also a 2nd degree black belt in Shingitai Jujitsu. Corey Humphreys (in red) demonstrating a leg lock on Gregg Humphreys (in blue). Corey Humphreys. Bettendorf, Iowa Corey has trained extensively in some form of grappling for over 25 years. Originally trained in Judo where he has achieved the rank of 2nd degree black belt, Corey has evolved his grappling repertoire to include sambo, Brazilian jiu- jitsu and wrestling. He believes that no one style is superior to another but feels that a combination of grappling arts is the best approach for success. He has trained with multiple world champions in Russia and Ukraine and has competed both nationally and internationally and is a former state judo champion. Vladislav Koulikov (in blue) applying a leg lock. Vladislav Koulikov. Florida, New York Vladislav Koulikov, Master of Sport, has been training Sambo since 1984, having received his training at Sambo 70 under the instruction of S.V. Vorotyagin, USSR & World Champion. Instructor Koulikov, was the 1989 Moscow Regional Sambo Champion and both a Gold and Silver Medalist in USSR National Sambo Championships. He holds a Black Belt in Judo & Ni Hon Kenpo Karate. Vlad was a member of the 2008 US World Team and has an extensive list of victories on the grappling scene; including the most technical athlete award at the very first Grappler’s Quest in 1998. Vlad was the Vice President of the American Sambo Association and can be seen on the big screen in “Salt” and “John Wick.” Lavell Marshall demonstrating a throw in Shuai Jiao. Lavell Marshall. New York, New York Lavell Marshall is a 4x USA Shuai Jiao Champion and current USA team member. He is a Baoding Combat Shuai Chiao (Chinese Wrestling) black belt and a Hung Ga (Tiger Crane Southern Shaolin) Kung Fu practitioner with rankings and experience in many other styles of Martial Arts (San Shou, TKD, Judo, BJJ, Sambo etc). Lavell is a competitive athlete and plans on pursuing an MMA career. Hotel Suggestions: The Marriott Hotel 50 N Martingale Road Schaumburg, IL 60173 847-240-0100 http://www.marriott.com/hotels/travel/chisb-chicago-marriott-schaumburg/ Courtyard Chicago/Schaumburg 1311 American Lane Schaumburg, IL 60173 847-619-8100 http://www.marriott.com/hotels/travel/chics-courtyard-chicago-schaumburg/ Motel 6 1000 West Devon Ave. Elk Grove Village, IL 60007 847-895-2085 https://www.motel6.com/en/motels.il.elk-grove%20village.4964.html La Quinta Inn Chicago O'Hare Airport/Elk Grove Village 1900 Oakton St. Elk Grove Village, IL 60007 847-439-6767 http://www.lq.com/lq/properties/propertyProfile.do?ident=LQ6072&propId =6072 .
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