LocationPalm Beach Combat Hapkido Wellington Recreation Center

Village Park, 11700 Pierson RoadWellington, Florida 33414

Payment(Make checks payable to Gil Levin)

Gil Levin, 1215 Clydesdale Drive Loxahatchee, FL 33470

561.818.5537 | Gilevin@aol.com

For more information about the seminar please visit palmbeachcombathapkido.com/seminaror call Master Gil Levin at 561.818.5537

Register before May 1st : $35 Register after May 1st : $45

Register before May 1st : $80 Register after May 1st : $90

Palm Beach Combat Hapkido

Self Defense Clinic & Ground Survival Seminar

May 11th & 12th, 2012

PresentsMaster David Rivas

Self Defense ClinicFriday, May 11th : 6 - 8PM

Ground Survival SeminarSaturday, May 12th : 9AM - 3PM

Learn practical, realistic techniques to defend your-self in everyday situations. The clinic will cover a variety of close quarter escaping, joint-locking, and ground survival techniques. It is open to everyone 9-years and up, no martial arts experience necessary.

Master David Rivas will teach, and clearly explain the strategies and tactics necessary to survive combat on the ground. The Combat Hapkido “Ground Survival” program is not about wrestling or ground grappling,

dangerous position in self defense, and quickly re-covering the dominant stand-up position.

Combat Hapkido Seminars

May 11 & 12, 2012

Wellington, Florida

Name: (Please Print)__________________________________________________ Date of Birth: _____________________ Address:___________________________________________________________ Phone:____________________________________________________________ E-Mail:____________________________________________________________ Friday, May 11, 2012 (6 – 8PM)

____ $35 - Self Defense Clinic (Preregistered by May 1, 2012)

____ $45 - Self Defense Clinic (Registered after May 1, 2012) Saturday, May 12, 2012 (9AM – 3PM)

____ $80 - Ground Survival Level 2 Seminar (Preregistered by May 1, 2012) ____ $90 - Ground Survival Level 2 Seminar (Registered after May 1, 2012) * Instructor certification available for qualified applicants. Applications will be available at the seminar.

** DVDs and other merchandise will be available for sale at the seminar.

Contact Information: Please make checks payable to “Gil Levin” and mail to: Master Gil Levin 1215 Clydesdale Drive Loxahatchee, Florida 33470 Phone: (561) 818-5537 E-mail: gilevin@aol.com

Liability and Notice of Assumption of Risk

I understand that I am participating in a Combat Hapkido Ground Survival Seminar. I understand that my payment is non-refundable. In the event

that you cannot attend, you will be allowed to attend future seminars hosted my Master Rivas. If you feel you are not physically fit to participate in

this seminar please consult a physician prior to attending. By signing this form I release David Rivas, and DTC Enterprises Inc. from any claim,

judgement, or expense arising out of any situation involving myself, or my property as a result of this seminar. I hereby voluntarily submit my

application for attendance and participation in said course and hereby assume all responsibilities for any and all damages, injuries or losses I may

sustain or incur while attending, participating and traveling to and from said activity. I hereby release and waive all claims against the sponsors,

promoters, organizers, operators, hosts, instructors, associations, schools, owners, officers, directors, employees and other participants connected

with said course individually or otherwise including the Village of Wellington and its officers and employees. I fully understand that in case of injury

the only medical treatment provided will be first-aid. I understand that I must strictly obey instructors and observe safety rules. I further agree that

any pictures and videotaping taken of me in connection with said course can be used for publication, promotion, articles, shows and advertisements

without additional consent and without compensation at this time or any other time. I understand that registration fees are non-refundable.

Signature:_________________________________________ Date:______________________