REGISTRATION FORM SEMINAR DETAILS DAN INOSANTO 2006 AUSTRALIAN TOUR BRISBANE: Name Age Wynnum North State High School Hall Wynnum Road. Address Saturday 9th December 2006 Postcode 9:00am to 12:00pm Home Phone Work Phone Sunday 10th December 2006 Mobile 9:00am to 12:00pm Email TRAINING EQUIPMENT: PLEASE TICK: Focus mitts, bag gloves, kali sticks, SYDNEY Thursday 7th Dec 2006 training knife SYDNEY Friday 8th Dec 2006 Equipment will be available for purchase at BRISBANE Saturday 9th Dec 2006 the seminar. (You can also order equipment ahead of time and we will have it ready for BRISBANE Sunday 10th Dec 2006 you to pick up at the registration desk). CAIRNS Wednesday 13th Dec 2006 ADELAIDE Friday 15th Dec 2006 MELBOURNE Saturday 16th Dec 2006 MELBOURNE Sunday 17th Dec 2006 INOSANTO INSTRUCTORS CONFERENCE Saturday 9th -Tuesday 12th Dec 2006 Please return application form and payment to your seminar representative SEMINAR COSTS: 1 Day: $100, 2 Days: $180 Amount Enclosed $ Cash (if paying in person) or CONTACT DETAILS TH write Cheque or Money Order to V. Vassiliou. For more information, call your local Progressive Martial Arts Academy representative or check our web sites Cookie Vassiliou www.progressivemartialarts.com.au 0412 400 836 www.ninopilla.com www.progressivemartialarts.com.au BIRTHDAY TOUR REGISTRATION FORM SEMINAR DETAILS DAN INOSANTO 2006 AUSTRALIAN TOUR BRISBANE: Name Age Wynnum North State High School Hall Wynnum Road. Address Saturday 9th December 2006 Postcode 9:00am to 12:00pm Home Phone Work Phone Sunday 10th December 2006 Mobile 9:00am to 12:00pm Email TRAINING EQUIPMENT: PLEASE TICK: Focus mitts, bag gloves, kali sticks, SYDNEY Thursday 7th Dec 2006 training knife SYDNEY Friday 8th Dec 2006 Equipment will be available for purchase at BRISBANE Saturday 9th Dec 2006 the seminar. (You can also order equipment ahead of time and we will have it ready for BRISBANE Sunday 10th Dec 2006 you to pick up at the registration desk). CAIRNS Wednesday 13th Dec 2006 ADELAIDE Friday 15th Dec 2006 MELBOURNE Saturday 16th Dec 2006 MELBOURNE Sunday 17th Dec 2006 INOSANTO INSTRUCTORS CONFERENCE Saturday 9th -Tuesday 12th Dec 2006 Please return application form and payment to your seminar representative SEMINAR COSTS: 1 Day: $100, 2 Days: $180 Amount Enclosed $ Cash (if paying in person) or CONTACT DETAILS TH write Cheque or Money Order to V. Vassiliou. For more information, call your local Progressive Martial Arts Academy representative or check our web sites Cookie Vassiliou www.progressivemartialarts.com.au 0412 400 836 www.ninopilla.com www.progressivemartialarts.com.au BIRTHDAY TOUR TERMS AND CONDITIONS PLEASE READ THE FOLLOWING CAREFULLY SIFU DAN INOSANTO 1. I, the undersigned acknowledge that I have applied to voluntarily participate in the Dan Inosanto Seminar. Sifu Dan Inosanto is the heir to 2. I am aware that participating in the practice of Jun Fan Gung Fu/Jeet Bruce Lee’s legacy of Jeet Kune Do Kune Do/Maphilindo Silat/Filipino Martial Arts, learning, training and and the only person ever to receive observing the practice of Jun Fan Gung Fu/ Jeet Kune Do/Maphilindo Silat/Filipino Martial Arts, and/or any other martial arts form that may instructorship certification in Jeet be demonstrated, practiced or taught during the Dan Inosanto Seminar Kune Do personally from Bruce Lee. may be a dangerous undertaking and in undertaking any such activities I do so at my own risk. From 1964 to 1973, Sifu Inosanto 3. I am also aware that it is a condition of admission to the Dan Inosanto was Bruce Lee’s private student, Seminar, that the Nino Pilla International Academy of Martial Arts Pty Ltd, the Progressive Martial Arts Academy, their directors, instructors, sparring partner, training partner members, servants or agents together with the Inosanto Academy, its and chief instructor of the Chinatown directors, servants or agents and the Dan Inosanto Seminar Sponsors are absolved from any liability howsoever arising from injury or damage JKD School in Los Angeles. howsoever caused (whether fatal or otherwise) arising out of participating in the Dan Inosanto Seminar, including learning, training and observing Sifu Inosanto will teach Jun Fan the practice of Jun Fan Gung Fu/ Jeet Kune Do/Maphilindo Silat/Filipino Gung Fu (kickboxing, trapping and Martial Arts and/or any other martial arts form that may be demonstrated, practiced, taught or observed during the Dan Inosanto Seminar, or in locking). He will also teach Filipino any way whatsoever due to any negligent act, breach of duty, default Kali and various systems of and/or omission on the part of the Nino Pilla International Academy of Martial Arts Pty Ltd, the Progressive Martial Arts Academy, their directors, Malaysian, Phillipine and Indonesian instructors, members, servants or agents, or on the part of the Inosanto Silat (Maphilindo Silat). Academy, its directors, instructors, members, servants or agents or on behalf of the Dan Inosanto Seminar Sponsors. He will show the drills, techniques 4. I am also aware that any person practicing, learning, training or and applications of both empty hand observing Jun Fan Gung Fu/ Jeet Kune Do/Maphilindo Silat/Filipino Martial Arts and/or participating, learning, training or observing any other and weapons. form or martial arts or any activity whatsoever carried out during the Take advantage of this opportunity Dan Inosanto Seminar are only allowed to do so on the distinct understanding that they do so at their own risk. to train with the legendary Dan 5. I acknowledge and am aware that participation in the Dan Inosanto Inosanto and experience first hand Seminar may involve extremely strenuous physical activity and to consult my doctor if I have any physical condition or impairment that may prevent his skill, grace and incredible wealth me from fully participating in the Dan Inosanto Seminar before commencing of knowledge spanning countless and undertaking such activity. I hereby represent that, to the best of my styles of martial arts. knowledge, I am in good physical health and condition, sufficient to undertake all activities and practices during the Dan Inosanto Seminar. 6. I understand that during the Dan Inosanto Seminar no photographs may be taken, and audio and video recording is strictly prohibited without prior express written consent of the Dan Inosanto Seminar Sponsors or Inosanto Academy. In addition, should I obtain prior written permission to take photographs; I agree that such photographs shall only be used by me and by no one else, for my own personal use and not for commercial gain or for any other purpose. I, of (Your name or that of a parent/guardian if under 18years) (Address) DO HEREBY ACKNOWLEDGE that of my own free will and desire I submit my application to participate in the Dan Inosanto Seminar for instruction and training in martial arts (Jun Fan Gung Fu/Jeet Kune Do/Maphilindo Silat/Filipino Martial Arts) activities mentioned above and that I have read and understood the warning in paragraph 5 above. Signed by the said (Signature) In the presence of Please cut and return with payment (Name of witness) (Signature of witness) TERMS AND CONDITIONS PLEASE READ THE FOLLOWING CAREFULLY SIFU DAN INOSANTO 1. I, the undersigned acknowledge that I have applied to voluntarily participate in the Dan Inosanto Seminar. Sifu Dan Inosanto is the heir to 2. I am aware that participating in the practice of Jun Fan Gung Fu/Jeet Bruce Lee’s legacy of Jeet Kune Do Kune Do/Maphilindo Silat/Filipino Martial Arts, learning, training and and the only person ever to receive observing the practice of Jun Fan Gung Fu/ Jeet Kune Do/Maphilindo Silat/Filipino Martial Arts, and/or any other martial arts form that may instructorship certification in Jeet be demonstrated, practiced or taught during the Dan Inosanto Seminar Kune Do personally from Bruce Lee. may be a dangerous undertaking and in undertaking any such activities I do so at my own risk. From 1964 to 1973, Sifu Inosanto 3. I am also aware that it is a condition of admission to the Dan Inosanto was Bruce Lee’s private student, Seminar, that the Nino Pilla International Academy of Martial Arts Pty Ltd, the Progressive Martial Arts Academy, their directors, instructors, sparring partner, training partner members, servants or agents together with the Inosanto Academy, its and chief instructor of the Chinatown directors, servants or agents and the Dan Inosanto Seminar Sponsors are absolved from any liability howsoever arising from injury or damage JKD School in Los Angeles. howsoever caused (whether fatal or otherwise) arising out of participating in the Dan Inosanto Seminar, including learning, training and observing Sifu Inosanto will teach Jun Fan the practice of Jun Fan Gung Fu/ Jeet Kune Do/Maphilindo Silat/Filipino Gung Fu (kickboxing, trapping and Martial Arts and/or any other martial arts form that may be demonstrated, practiced, taught or observed during the Dan Inosanto Seminar, or in locking). He will also teach Filipino any way whatsoever due to any negligent act, breach of duty, default Kali and various systems of and/or omission on the part of the Nino Pilla International Academy of Martial Arts Pty Ltd, the Progressive Martial Arts Academy, their directors, Malaysian, Phillipine and Indonesian instructors, members, servants or agents, or on the part of the Inosanto Silat (Maphilindo Silat). Academy, its directors, instructors, members, servants or agents or on behalf of the Dan Inosanto Seminar Sponsors. He will show the drills, techniques 4. I am also aware that any person practicing, learning, training or and applications of both empty hand observing Jun Fan Gung Fu/ Jeet Kune Do/Maphilindo Silat/Filipino Martial Arts and/or participating, learning, training or observing any other and weapons. form or martial arts or any activity whatsoever carried out during the Take advantage of this opportunity Dan Inosanto Seminar are only allowed to do so on the distinct understanding that they do so at their own risk.