DAN INOSANTO - ninopilla
DAN INOSANTO - ninopilla
DAN INOSANTO - ninopilla
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Name<br />
PLEASE TICK:<br />
REGISTRATION FORM SEMINAR DETAILS<br />
BRISBANE WORKSHOP 1 Thursday, 29 Nov 2012<br />
BRISBANE WORKSHOP 2 Friday, 30 Nov 2012<br />
BRISBANE SEMINAR 1 Saturday, 1 Dec 2012<br />
BRISBANE SEMINAR 2 Sunday, 2 Dec 2012<br />
ADELAIDE WORKSHOP Thursday, 6 Dec 2012<br />
ADELAIDE SEMINAR Friday, 7 Dec 2012<br />
MELBOURNE SEMINAR 1 Saturday, 8 Dec 2012<br />
MELBOURNE SEMINAR 2 Sunday, 9 Dec 2012<br />
IIMAIA INSTRUCTORS COURSE<br />
1 - 4 December 2012 (by invitation only)<br />
WORKSHOP / SEMINAR COSTS:<br />
1 Day: $110* / $130 2 Days: $200* / $250<br />
3 Days: $300* / $330 4 Days: $400* / $440<br />
*Pre-paid ticket prices only valid if payment received<br />
before Thursday, 1 November 2012.<br />
Please return this application form and payment<br />
to your seminar representative:<br />
In Person: By Cash, Cheque or Money Order<br />
Mail: Cheque or Money Order written out<br />
to V. Vassiliou and mail to:<br />
PO Box 9106, Wynnum Plaza, Wynnum QLD 4178<br />
Visa / Mastercard: By Phone (07) 3393 9329<br />
or Online at www.progressivemartialarts.com.au<br />
Electronic Funds Transfer (EFT):<br />
Account Name: Progressive Martial Arts<br />
BSB: 064 133 Account: 1027 4248<br />
Please include your Name and State as reference<br />
BRISBANE:<br />
Silat (TBC) Workshop Muay Thai Workshop<br />
Thurs, 29 Nov 2012 Fri, 30 Nov 2012<br />
6pm to 8pm 5:30pm to 7:30pm<br />
Jun Fan / Kali / JKD / Silat Jun Fan / Kali / JKD / Silat<br />
Sat, 1 Dec 2012 Sun, 2 Dec 2012<br />
9am to 12pm 9am to 12pm<br />
Progressive Martial Arts Academy International<br />
Unit 2/95 Ingleston Road, Wakerley, QLD, 4154<br />
Contact: Cookie and Q Vassiliou<br />
T: (07) 3393 9329 www.progressivemartialarts.com.au<br />
ADELAIDE:<br />
Muay Thai Workshop Jun Fan / Kali / JKD / Silat<br />
Thu, 6 Dec 2012 Fri, 7 Dec 2012<br />
6:30pm to 8:30pm 6:30pm to 9:30pm<br />
Nino Pilla International Academy of Martial Arts<br />
Basement, 118 King William Street, Adelaide SA 5000<br />
Contact: Nino Pilla<br />
T: (08) 8212 5606 www.<strong>ninopilla</strong>.com<br />
MELBOURNE:<br />
Jun Fan / Kali / JKD / Silat Jun Fan / Kali / JKD / Silat<br />
Sat, 8 Dec 2012 Sun, 9 Dec 2012<br />
10:30am to 1:30pm 10:30am to 1:30pm<br />
Progressive Martial Arts Academy, Melbourne<br />
3 Olive Street Malvern East Victoria 3145<br />
Contact: Bruce McCulloch<br />
T: 0405 131 812 www.progressivemaam.com.au<br />
TRAINING EQUIPMENT<br />
Focus mitts, bag gloves, kali sticks, training knife.<br />
Training equipment and merchandise will be available<br />
to purchase on the day and can be pre-ordered.<br />
BRISBANE<br />
29 NOV - 4 DEC<br />
(07) 3393 9329<br />
ADELAIDE<br />
6-7 DEC 2012<br />
(08) 8212 5606<br />
MELBOURNE<br />
8-9 DEC 2012<br />
0415 131 812<br />
The human encyclopedia of martial arts<br />
<strong>DAN</strong> <strong>INOSANTO</strong><br />
2012 Australian Tour
The human encyclopedia of martial arts<br />
An opportunity to meet and train with Guro Dan Inosanto.<br />
A true pioneer of the Mixed Martial Arts and one of the<br />
most renown and sought after instructors in the business.<br />
Whether you are a beginner or a master in any of the<br />
martial arts, The Inosanto Tour will be sure to inspire.<br />
Arts covered include: Jeet Kune Do, Filipino Martial Arts,<br />
Silat, Muay Thai and many more.<br />
BROUGHT TO YOU BY PROGRESSIVE MARTIAL ARTS ACADEMY INTERNATIONAL AND NINO PILLA INTERNATIONAL ACADEMY OF MARTIAL ARTS<br />
PLEASE READ THE FOLLOWING CAREFULLY<br />
1. I, the undersigned acknowledge that I have applied to voluntarily participate in the Dan Inosanto Seminar.<br />
2. I am aware that participating in, learning, training and observing the practice of Jun Fan Gung Fu /<br />
Jeet Kuen / Maphilindo Silat / Filipino Martial Arts / Muay Thai and/or any other martial arts form that<br />
may be demonstrated, practiced or taught during the Dan Inosanto Seminar may be a dangerous<br />
undertaking and in undertaking any such activities I do so at my own risk.<br />
3. I am also aware that it is a condition of admission to the Dan Inosanto Seminar, that the Nino<br />
Pilla International Academy of Martial Arts Pty Ltd, the Progressive Martial Arts Academy, their<br />
directors, instructors, members, servants or agents together with the Inosanto Academy, its<br />
directors, servants or agents and the Dan Inosanto Seminar Sponsors are absolved from any liability<br />
howsoever arising from injury or damage howsoever caused (whether fatal or otherwise) arising<br />
out of participating in the Dan Inosanto Seminar, including learning, training and observing the<br />
practice of Jun Fan Gung Fu / Jeet Kuen / Maphilindo Silat / Filipino Martial Arts / Muay Thai and/<br />
or any other martial arts form that may be demonstrated, practiced, taught or observed during the<br />
Dan Inosanto Seminar, or in any way whatsoever due to any negligent act, breach of duty, default<br />
and/or omission on the part of the Nino Pilla International Academy of Martial Arts Pty Ltd, the<br />
Progressive Martial Arts Academy, their directors, instructors, members, servants or agents, or on<br />
the part of the Inosanto Academy, its directors, instructors, members, servants or agents or on<br />
behalf of the Dan Inosanto Seminar Sponsors.<br />
4. I am also aware that any person practicing, learning, training or observing Jun Fan Gung Fu / Jeet<br />
Kuen / Maphilindo Silat / Filipino Martial Arts / Muay Thai and/or participating, learning, training or<br />
observing any other form or martial arts or any activity whatsoever carried out during the Dan Inosanto<br />
Seminar are only allowed to do so on the distinct understanding that they do so at their own risk.<br />
5. I acknowledge and am aware that participation in the Dan Inosanto Seminar may involve extremely<br />
strenuous physical activity and to consult my doctor if I have any physical condition or impairment<br />
that may prevent me from fully participating in the Dan Inosanto Seminar before commencing and<br />
undertaking such activity. I hereby represent that, to the best of my knowledge, I am in good physical<br />
health and condition, sufficient to undertake all activities and practices during the Dan Inosanto Seminar.<br />
6. I understand that during the Dan Inosanto Seminar no photographs may be taken, and audio and<br />
video recording is strictly prohibited without prior express written consent of the Dan Inosanto<br />
Seminar Sponsors or Inosanto Academy. In addition, should I obtain prior written permission to take<br />
photographs; I agree that such photographs shall only be used by me and by no one else, for my<br />
own personal use and not for commercial gain or for any other purpose.<br />
I, of<br />
(Your name)<br />
(Address)<br />
(Postcode)<br />
(Home Phone) (Work Phone) (Mobile)<br />
(Email) (Age)<br />
DO HEREBY ACKNOWLEDGE that of my own free will and desire I submit my application to participate<br />
in the Dan Inosanto Seminar for instruction and training in martial arts (Jun Fan Gung Fu/Jeet Kuen/<br />
Maphilindo Silat/Filipino Martial Arts) activities mentioned above and that I have read and understood the<br />
warning in paragraph 5 above.<br />
Signed by the said<br />
(Signature or that of a parent/guardian if under 18years))<br />
In the presence of<br />
TERMS & CONDITIONS<br />
(Name of witness) (Signature of witness)