Registration Form
Fill out the form carefully for registration
Participant Name
First Name
Middle Name
Last Name
Birth Date
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Day
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Gender
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Male
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N/A
Address
Street Address
Street Address Line 2
City
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E-mail
example@example.com
Mobile Number
Phone Number
Where do you train?
Rank
Instructor
RELEASE OF LIABILITIES
I agree to accept full responsibility for any and all injuries that I may sustain during this activity. I release the CT Chung Do Kwan, LLC and all members affiliated with aforementioned party from all liabilities. In case of injury and/or an emergency, I would like you to contact:
Emergency Contact Name
Emergency Contact Phone
My Products
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USA Golden Warriors Poomsae Camp Registration
$
250.00
Credit Card
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