IIMALECT Hall of Fame Nominee Registration

Nominee Full Name*

First NameLast Name

Nominee Email Address*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Nominee Phone Number*

Country CodeArea CodePhone Number

Nominee Country of Residence*

Nominee Profession/Title*

Main Martial art*

Martial art degree*

Age or Date of birth (dd/mm/yyyy)*

How Long in the Martial Arts?*

What is the name of your teacher

Are You Actively Teaching Now?*

YesNo

Additional Notes or Achievements

Will You Attend the National Training Camp? (Free to Inductees)*

Yes as a practitionerYes I would like also to teach for 20-30 minutesNo

Will You Attend the Banquet?*

YesNo

My Products*

Induction Honor Fee (Full Attendance)Induction Honor Fee (Full Attendance)

€350.00 Quantity

Remote Attending IIMALECT Hall of Fame AwardRemote Attending IIMALECT Hall of Fame Award

€250.00 Quantity

Official Commemorative Swag Package by IIMALECTPolo Shirt, lapel pin, patch (include international shipping)

€100.00 QuantityPolo shirt size

Hall of Fame Silver ring925 special Hall of fame ring

€360.00 Quantity

Donation for PTSD combat veteransDonation to PTSD Combat Veterans (Special Assistance Scholarship Fund by IIMALECT)

€50.00 Quantity

Enter coupon

Total

€0.00

Hall of Fame ring size

Who Nominated You?

Participant Declaration and Liability Waiver

International Institute of Martial Arts, Law Enforcement, and Counter-Terrorism - Hall of Fame Seminar & Banquet – Participant Agreement

I, the undersigned, hereby formally request the honor and privilege of admission to the official seminar and/or banquet organized by the International Institute of Martial Arts, Law Enforcement, and Counter-Terrorism (IIMALECT), to be held at the location and date specified by the institution.

I fully acknowledge that the instructional sessions and physical activities offered during this event are martial arts oriented, and may include intense physical exertion and direct physical contact. I understand that the practice of martial arts and defensive tactics carries inherent risk, including the possibility of serious injury or even death.

Furthermore, I am fully aware that IIMALECT, its event partners and co hosts, instructors, representatives, and the venue staff do not provide insurance coverage of any kind for participants, nor do they assume any responsibility for personal injuries, illnesses, property damage, or other unforeseen circumstances related to this event.

In consideration of being granted access to participate in the course, to receive instruction, and to utilize the facilities provided by the host organization during the seminar and/or banquet, I voluntarily and unconditionally assume full responsibility for any injury, illness, or loss incurred by me, on or off the premises, before, during, between, or after sessions or banquet activities.

I hereby fully release and discharge IIMALECT, its directors, staff, event organizers, instructors, volunteers, agents, and affiliates, as well as the seminar venue and all associated entities, from any and all liability, claims, demands, legal actions, damages, or obligations past, present, or future arising from or related to my participation in the event.

This waiver is binding upon me, my heirs, assigns, personal representatives, and legal beneficiaries. I further agree not to pursue any form of legal or equitable action against any of the aforementioned entities in relation to any matter arising from this event.

By signing this document, I also grant IIMALECT the right to use photographs and video footage in which I may appear, for promotional, archival, or educational purposes, without expectation of compensation

Do You Accept the Induction for our Hall of Fame*

YesNo

Nominee Signature*