Shoshin Ryu Membership Registration

Please check one Please check one New Member Renewal

First Name

Last Name

Mailing Address

Birthdate

Age

Cell Phone:

Email

Belt Rank

Dojo Affiliation

Instructor

Memberships are for the current calendar year from January through December 31 Memberships are for the current calendar year from January through December 31 $25.00 - Junior Membership Dues (Under 17 yrs old) $30.00 - Adult Kyu Rank Membership Dues $40.00 - Black Belt Membership Dues

I am fully aware of the risks and potential injuries which is inherent in martial arts activities. By submitting this form, the undersigned agrees to release Shoshin Ryu Yudanshakai ("SRY"), its professors, its instructors, its volunteers, and principals & associates from such claims or responsibilities for injuries, property damages, or even death that it may occur from any SRY activities WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I have read (or have read to me) this release of liability, fully understand its terms, understand that I have given up substantial rights by submitting it freely and voluntarily without any inducement.