________________________________________________________________________________________________________

(Name)(Age)(Phone number)

________________________________________________________________________________________________________

(Street address)(Apartment or P. O. Box number)

________________________________________________________________________________________________________

(City)(State)(Zip code)

NOTE: Regular fee, $249. If received before June 1, pay only $199 for instruction. All participants must complete the application form and sign the waiver.

For office use only: ________DP________BAL________G5-9________G10+

________ Pay only $99 non-refundable deposit. The balance of $100 is due at check-in.

________ I am an agent of AIKIA. My agent identification number is _______________.

________ I am a member of a group of five or more participants. To qualify for group rates, a single leader must collect all applications and fees to be mailed in one package. We recommend for the best Karate College rates Best Western Radford Inn, (540) 639-3000, and Super 8 Motel, Radford, (540) 731-9355. 

Group Leader: _____________________________________________________

________ I am a non-participating parent of a child enrolled in Karate College 2008. $49 all-inclusive spectator pass.

My Child’s Name:

___________________________________________________

________ I missed the June 1, 2008, deadline. Enclosed is my $99 deposit. I will pay the balance of $150 at check-in.

Note: Confirmation letters will be mailed to all pre-registered campers during the first week of June. Please make all checks/money orders payable to: Karate College 2008. Mail applications and fees to: Karate College, P. O. Box 402, Christiansburg VA  24068. For more information, call (540) 381-2025.

Waiver

I have had previous martial arts instruction, and I understand that practice in the Karate College 2008 (June 26-29) may be dangerous and that, by participating in this program, I may be seriously injured. I freely waive all rights to Dr. Jerry Beasley, the instructors, and staff of Karate College 2008, and to Radford Recreation Center. I have accident and/or medical insurance to cover any injury that I might sustain; therefore, in return for admission to the camp, I forever give up any rights against Dr. Jerry Beasley, Radford Recreation center, and Karate College 2008 promoters, instructors, and staff. My signature is proof of my intention and understanding of this policy.

_______________________________________________________________________________________________

(Signature of participant)(Age)(Date)

_______________________________________________________________________________________________

(Name of parent or legal guardian if participant is under age 18 years)

_______________________________________________________________________________________________

(Signature of parent or guardian)(Date)

Radford University Lodging Reservations

Note: If you plan to stay on the Radford University campus, contact RU Conference Services by June 10, 2008, to ensure lodging availability, (540) 831-5800 or (540) 831-6037, e-mail: TRidpath@Radford.edu.

2008 Prices for air conditioned dorm rooms:

Double occupancy, June 26-28, $78.27 per person

Private room, June 26-28, $108.24 per person

Double occupancy, June 27-28, $54.18 per person

Private room, June 27-28, $72.16 per person

Meals are available in Muse Hall cafeteria (cash at the door). For on-campus lodging, make checks payable to RU Conference Services and mail to: P. O. Box 6911, Radford University, Radford VA  24142. Master Card and Visa accepted. Fax: (540) 831-6036.

www.AIKIA.net

Dr. Jerry Beasley

P. O. Box 402

Christiansburg VA  24068

21st Anniversary

June 26-29, 2008

Co-sponsored by Century Martial Arts