SUDA International, LLP Presents
CONTROL FACTOR
SEMINAR
Name:
_____________________________________________________________________________
Age: _______
Birthdate: / / Phone: ( ) - .
Address:
Emergency Contact: ____________________________
Emergency Number: ( ) - .
E-Mail: _______________________@_________________ Department:
_________________________
Position/Rank: ______________________________________
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REGISTRATION
INFORMATION |
PAYMENT INFORMATION |
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QTY COST S.TOTAL Seminar _____ February 27, 2010 $100 _________ STDA Association _____ Membership FREE FREE TOTAL PAYMENT AMOUNT: $_________ NOTE: Payments are made payable to: SUDA International, LLP |
Name (As it appears on
Credit Card): Payment Type: □ Visa □ Master Card □ Discover □ Check
#_________ □ Money Order Credit Card Billing Address
(NOT P.O. Box): __________________________________________ Card Number:
______________________________ Expiration: __________ |
The signature below
acknowledges your authorization for the charges listed above to be charged to
your credit card, also listed above.
Customer Signature:
____________________________________________________
Printed Name:
______________________________ Date: __________ Location: ___________________
Information obtained on this form, is private and
confidential. Information will ONLY be used for the purpose of processing the
above charges.
MAIL
FORMS AND PAYMENT TO:
SUDA
International, LLP. 2405-B Essington
Road PMB 115
Received By: ________________________________________
Print: __________________________________
Date:
__________________________ Processed: __________
RELEASE AND INDEMNIFICATION AGREEMENT
This agreement (“Agreement”)
is made and entered into this _______day of _________, 200__, by and between
SUDA International, LLP. An Illinois Limited Liability Partnership (“SUDA”),
and ___________________________ (“Participant”).
1.
Representations. I, ________, the Participant, an adult over
the age of eighteen (18) years, am aware that SUDA has professional expertise
and experience in providing various martial arts and fitness training programs,
demonstrations, courses and instruction (collectively, the “Program”), and have
solicited SUDA’s consent to participate in the Program of my own free will,
based on my own desire and interest therein. I further acknowledge that,
through my own knowledge of martial arts and fitness programs similar to those
comprising the Program and also through information provided to by about the
Program by SUDA, I am familiar with the risks inherent in martial arts and
fitness training programs such as those comprising the Program which involve
physical activity, exercise or exertion, and without in any way limiting the
generality of the foregoing, I specifically acknowledge that (i) the type of martial
arts and fitness training programs comprising the Program may involve physical
contact between myself and other participants in the Program and/or employees
or agents of SUDA, which contact may include, but will not necessarily be
limited to punching, striking, hitting and kicking, and which contact
necessarily involves a risk of bodily injury and/or death and (ii) that the
activities comprising the Program may involve strenuous physical activity,
which physical activity necessarily involves a risk of bodily injury and/or
death. I further acknowledge that after being informed of and reviewing the
nature of the Program, and the risks inherent therein, I am voluntarily
choosing to participate in the Program and to execute this Agreement, that I am
voluntarily assuming any and all risk of bodily injury, illness, disability,
physical condition or limitation that would endanger my health and well-being
by virtue of my participation in the Program, that I now have and will maintain
during my participation in the Program, hospitalization and major medical
insurance coverage that is sufficient to defray any expenses which I may incur
for medical treatment or hospitalization in connection with any injury,
illness, disability, physical condition or limitation that I may sustain during
my participation in the Program, and that SUDA shall bear no responsibility or
have any liability whatsoever to me or any other person or entity claiming
through me or on my behalf for any such medical or hospitalization expenses of for
any other costs, claims, damages, demands, losses, judgments, fees, duties,
charges, liabilities, obligations, suits (whether at law or in equity),
proceedings, or debts of whatever nature or kind, arising out of or in any way
related to my participation in the Program, whether now or hereinafter in
existence.
1.
Release and
Indemnification. I, ________, the Participant, in
consideration of SUDA’s consent to my participation in the Program, of my own
free will and volition, do hereby release, forbear and waive any and all
claims, costs, damages, demands, losses, judgments, fees, duties, charges,
liabilities, obligations, suits (whether at law or in equity), proceedings, or
debts of whatever nature or kind, arising from or otherwise related to in any
way my participation in the Program, whether now or hereinafter in existence,
and do hereby agree to indemnify, defend and hold SUDA harmless of and from any
such claims, costs, damages, demands, losses, judgments, fees (including but
not limited to attorney’s fees, consultants’ fee or expert witness fees),
duties, charges, liabilities, obligations, suits (whether at law or in equity),
proceedings, or debts asserted against SUDA by me, by any person or entity
claiming through me or on my behalf or by virtue of my participation in the
Program.
2.
Scope and
Effect. I, ________, the Participant, agree that this
Agreement is intended to be broadly construed in favor of SUDA to the fullest
extent permitted by the law of the State of
Having carefully and fully reviewed this Agreement, I, the Participant,
hereby knowingly and voluntarily execute this Agreement as of the date first
above named.
______________________________________________
Participant (Adult Signature Required if Under 18
Years)
______________________________________________
Print Name
Please fill out form in its
entirety. Clearly print date and “participant” name. Initial each small line
with the signor’s initials. Sign and print your name at the bottom. Please
include this form for each participant.