MARTINEZ ACADEMY OF ARMS

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REDWOOD RAPIER CAMP

Registration Form

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Name:____________________________________________________________________


Address:_________________________________________________________________


City:______________________ State:_____ Zip:________  Country: __________


Date of Birth: Month:____ Day:____ Year:______  Gender: [ ]Male [ ]Female


Home Phone: (______)______-______

Work Phone: (______)______-______

Fax: (______)______-______

E-mail: ________________________________________

A minimum deposit of $200 is required with the registration. The total price for the seminar including lodging, meals and tuition is $625 if registration is postmarked May 20 or earlier; after May 20 the cost of the seminar is $725. Payment is due in full by June 20. After June 20 no refunds of any payments or deposits will be given under any circumstances. Any payments received after the camp is full will be returned to the sender. If your registration is accepted you will receive a letter of confirmation by mail and/or email. Participants must be 18 years old and over.

Make your check or money order payable to Antone Blair; do not send cash.

Amount Enclosed: _______

You will need to bring your own equipment, including a practice rapier, practice dagger, 3-weapon fencing mask, jacket, and gloves at minimum. HSU may be able to provide SOME equipment, but ONLY if you contact Antone Blair to make arrangements before June 13, 2004.

Which school of rapier fence do you wish to study at this camp?

[  ] Spanish        [  ] Italian

If there are particular people with whom you would like to share a room, please list them in order of preference below (this information will be kept confidential)

Roommate requests:

1 _________________

2 _________________

3 _________________

Requests for roommates are not guaranteed.

In the space below, briefly describe how much experience you have in historical rapier fencing:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Do you have any existing medical conditions which you feel the instructors and/or staff should be aware of?

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Waiver of Liability

You must sign this waiver of liability in order to be enrollment. I understand and appreciate that participation in fencing carries a risk to me of serious injury, including permanent paralysis or death. I knowingly recognize, accept, and assume this risk and voluntarily release and hold harmless Humboldt State University and the Martinez Academy of Arms, their instructors, students, affiliates, & participants from any liability.

______________________________________________        _______________
Fencer/Student Signature                              Date

Please direct any further questions to Antone Blair: email sildar1@earthlink.net, phone (707) 826-0573, or write to the address below.

Mail this completed application with payment to:

Antone Blair
Redwood Rapier Camp
1348 I Street
Arcata, CA 95521