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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: ________________________________________
Participants must be 18 years old and over.
The total price for the seminar including lodging, meals and tuition is $665 if registration is postmarked April 17 or earlier; after April 17 the cost of the seminar is $765. Payment is due in full by May 17. After May 17 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. A minimum deposit of $200 is required with the registration.
There will be a capstone session on Saturday, June 23, from 10am until 2pm. The cost of this session is an additional $50.
[ ] Register me for the Saturday class
The standard registration price includes lodging until 12pm on Saturday. You may extend your stay in the dormitory one additional night at a cost of $60 per person.
[ ] Register me for One Extra Night of Lodging
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 May 17, 2007.
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, with the exception of couples.
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?
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
You must sign the waiver of liability in order to be enrolled.
By signing below, the participant agrees to abide by all rules as stated by the organizers and instructors (hereafter collectively referred to as “the camp officials”) affiliated with the Redwood Rapier Camp (hereafter “the camp”).
You must sign this waiver of liability in order to be enrolled. 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 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
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