Kangeiko Seminar Kenjutsu and Aikido Seminar - February 18-20, 2011 - Kenjutsu: Meik Skoss Sensei Aikido: Lisa Tomoleoni Sensei Friday: 6:30-8:30 pm Saturday: 9:00 am-5:30 pm Sunday: 9:30 am-12:30 pm Seminar cost: All 3 days- $60 Fri. - $25 Sat. - $40 Sun. - $30 9225 Trinity Drive Lake in the Hills, IL (847) 458-9309 www.aikidoshimbokudojo.com Seminar February 18-20, 2011 Information and Registration Form Meik Skoss lived and trained in a number of modern and classical martial arts in Japan between 1973 and 1997. He is currently the Dojo-cho of the Shutokukan in New Jersey, where he teaches Shinto Muso-ryu Jojutsu and its related arts, Toda-ha Buko-ryu Naginatajutsu, and Yagyu Shinkage-ryu Hyoho Kenjutsu and Yagyu Seigo-ryu Battojutsu. He holds the rank of go-mokuroku in Shinto Muso-ryu jo and Sandan in jodo from the All Japan Kendo Federation. He holds Yondan in Aikido along with ranking in many other modern and classical arts. Lisa Tomoleoni has been training in Aikido for more than 20 years. She holds the rank of Godan, which she received from Ueshiba Moriteru Doshu. During her 13 years living and training in Japan, she taught Aikido professionally. She also holds Yudansha ranking in Iaido and Kodokan Judo. ------------------------------------------------------------------------------------------------------------------------------- Please complete REGISTRATION and WAIVER. Mail with a check [Made payable to “Aikido Shimboku Dojo”] to: Aikido Shimboku Dojo 9225 Trinity Drive Lake in the Hills, IL 60156 Name: __________________________________________________________________________________ Address:________________________________________________________________________________ City/State/Zip _____________________________________ Telephone Number: _____________________ Email Address: __________________________________________________________________________ Dojo / Affiliation / Rank: ___________________________________________________________________ __ All days $60 __ Friday only $25 __ Saturday only $40 __ Sunday only $30 Seminar Waiver I, the undersigned, promise to accept and follow all rules and regulations set forth by Aikido Shimboku Dojo. I represent that I have attained my legal majority and that I am fully competent to take all action with respect to this application. I further represent that I know that I am in good physical condition to receive Aikido and Kenjutsu instruction and training, understanding that such training involves violent and strenuous physical exercise. Furthermore, I hereby expressly assume ALL RISKS of danger to my person, including risks of injury due to negligent conduct by anyone connected in any way to Aikido Shimboku Dojo, its instructors, directors, officers, agents, employees, members and other students (whether regular, temporary, or other classification) enrolled with Aikido Shimboku Dojo on February 18,19,20, 2011. I further hereby expressly waive and forgo all suits, claims, demands or any kind and character, damages, including damages for injuries resulting from negligence, loss of services, expenses, and compensation growing out of any and all known and unknown personal injuries resulting from the study and practice of Aikido and/or Kenjutsu on February 18,19,20, 2011, and from or while participating in exhibits, seminars and other events of Aikido Shimboku Dojo while under the supervision and control of Aikido Shimboku Dojo, which I, my heirs, executors, administrators, and assigns hereafter can, shall or may have. I further agree to hold Aikido Shimboku Dojo and other persons described above, harmless from all suits, claims, demands, damages, including damages for injuries resulting from negligence, loss of services, expenses, and compensation of any kind or character arising out of my visiting or training with Aikido Shimboku Dojo on February 18,19,20, 2011. IN WITNESS WHEREOF, I have signed my name this day of ________________________________, 2011. ____________________________________________________________________________ Signature Printed Name ____________________________________________________________________________ In Case of Emergency, Notify Relationship and Phone .