2012 FOURTH ANNUAL NAMA SCHOOL OF CDK TRAINING CAMP APPLICATION
(One Application per Participant)
NAMA School of CDK
Brad Bransky
1690 W. Sunshine Dr.
Flagstaff, AZ 86001
Telephone W (928) 679-7700, Cell (928) 266-5320, bradb42@yahoo.com
Fax (928) 679-7701

NAME       ____________________________ TELEPHONE (____) __________            

ADDRESS ___________________________________________       AGE _______       

                   ___________________________________________      RANK ______

E-MAIL     ____________________________________________

SCHOOL AFFILIATION ___________________________________________                                             

INSTRUCTOR ____________________________________________________                                                      

TEE SHIRT SIZE:   XXXL   XXL    XL    LG    MED    SM

WAIVER

I the undersigned, do hereby voluntarily submit my application for attendance and participation in the Fourth Annual NAMA School of CDK Training Camp and hereby assume full responsibility for any and all damages, injuries, or losses that I sustain or incur, if any, while attending or participating, and I waive all claims against promoters, operators, instructors, or sponsors of said Training Camp individually or otherwise from any claims for injuries that I might sustain.  I fully understand that any medical treatment given me will be of a first aid treatment type only.  If participant is under 18, this release and consent is to be signed by Parent or Guardian.

Signed                                        _____________________    Date _________         
Participant  (Parent or Guardian if Participant is under 18)