REGISTRATION FORM

 
　

CHEN STYLE TAI CHI, XING YI, BA GUA SEMINAR

January 20  – January 21, 2007

Please fill out the following form and return to: 
　

King Lam’s Chen Style Tai Chi Center

7527 Freret Street

New Orleans, LA 70118

504-866-2241 
　

Name (Print) ________________________________________ Date: _____________

 
　

Phone: ___________________________ Email ________________________________ 
　

Address: _________________________________State: ________Zip: ____________ 
　

Full Time Tuition $250.00 minus $20.00 before January 1, 2007 equals $230.00. Registration priority will be given to full-time participants. Make your check payable to :

Chen Style Tai Chi. 
　

Paid by:  Cash or Check, Date_______________ Amount Paid_________________ 
　

Balance due__________________ Staff Initials_______________________________ 
　

Part time tuition will be $20.00 each session. There will be 7 hours on Saturday and Sunday. Please list the sessions that you will attend.  See detailed schedule on www.chenstyletaichi.com go to our News link or www.kinglamtaichi-karate.com.  go to Events link for registration form and more information.

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If you have any questions, please email kinglam1131@yahoo.com. 
　

                                             

List your Style_________________________________________________ 
　

Experience and Training Level___________________________________ 
　

                                       
 
 
 
 
 
 
　

USA CHEN TAI CHI FEDERATION

RELEASE OF LIABILITY AND WAIVER

Seminar Participant Name: ______________________________________

Seminar Dates: _________________________________________________ 
　

Please read and sign below 
　

Release:  Student/Seminar participant (now called student) acknowledges the existence of certain risks inherent in any health or martial arts training and hereby agrees and assumes all risks of injury and loss to student.  Student agrees to hold harmless and releases the property owner, USA Chen Tai Chi Federation (USACTCF), its owner, staff and management, and his or her fellow students from any liability for damages resulting from any loss due to theft or injury to the student’s person or property.  Student also agrees that as a student or parent, any pictures that are taken during the USACTCF events may be used by USACTCF for the purposes of promoting the school, federation including but not limited to brochures, flyers and websites. 
　

I understand that the following refund policy applies for all Seminar Tuition Paid.

A full refund of the deposit is available if cancellation notice is received before December 1, 2006.  Deposits will be refunded at a 50% rate for cancellations after December 1 and up until January 1, 2007.  Cancellation after that time cannot be refunded. 
　

By my signature below, I affirm that I have read, understood and agree to the above terms and conditions.

Print Name: _____________________________________

 
　

Signature: _______________________________________Date: __________________