BRISBANE:

Silat (TBC) Workshop Muay Thai Workshop Thurs, 29 Nov 2012 Fri, 30 Nov 2012 6pm to 8pm 5:30pm to 7:30pm

Jun Fan / Kali / JKD / Silat Jun Fan / Kali / JKD / Silat Sat, 1 Dec 2012 Sun, 2 Dec 2012 9am to 12pm 9am to 12pm

Progressive Martial Arts Academy International Unit 2/95 Ingleston Road, Wakerley, QLD, 4154 Contact: Cookie and Q Vassiliou T: (07) 3393 9329 www.progressivemartialarts.com.au

ADELAIDE:

Muay Thai Workshop Jun Fan / Kali / JKD / Silat Thu, 6 Dec 2012 Fri, 7 Dec 2012 6:30pm to 8:30pm 6:30pm to 9:30pm

Nino Pilla International Academy of Martial Arts Basement, 118 King William Street, Adelaide SA 5000 Contact: Nino Pilla T: (08) 8212 5606 www.ninopilla.com

MELBOURNE:

Jun Fan / Kali / JKD / Silat Jun Fan / Kali / JKD / Silat Sat, 8 Dec 2012 Sun, 9 Dec 2012 10:30am to 1:30pm 10:30am to 1:30pm

Progressive Martial Arts Academy, Melbourne 3 Olive Street Malvern East Victoria 3145 Contact: Bruce McCulloch T: 0405 131 812 www.progressivemaam.com.au

Focus mitts, bag gloves, kali sticks, training knife. Training equipment and merchandise will be available to purchase on the day and can be pre-ordered.

Name

PLEASE TICK:

BRISBANE WORKSHOP 1 Thursday, 29 Nov 2012

BRISBANE WORKSHOP 2 Friday, 30 Nov 2012

BRISBANE SEMINAR 1 Saturday, 1 Dec 2012

BRISBANE SEMINAR 2 Sunday, 2 Dec 2012

ADELAIDE WORKSHOP Thursday, 6 Dec 2012

ADELAIDE SEMINAR Friday, 7 Dec 2012

MELBOURNE SEMINAR 1 Saturday, 8 Dec 2012

MELBOURNE SEMINAR 2 Sunday, 9 Dec 2012

IIMAIA INSTRUCTORS COURSE 1 - 4 December 2012 (by invitation only)

WORKSHOP / SEMINAR COSTS:

1 Day: $110* / $130 2 Days: $200* / $250

3 Days: $300* / $330 4 Days: $400* / $440

*Pre-paid ticket prices only valid if payment received before Thursday, 1 November 2012.Please return this application form and payment to your seminar representative:

In Person: By Cash, Cheque or Money Order

Mail: Cheque or Money Order written out to V. Vassiliou and mail to: PO Box 9106, Wynnum Plaza, Wynnum QLD 4178

Visa / Mastercard: By Phone (07) 3393 9329 or Online at www.progressivemartialarts.com.au

Electronic Funds Transfer (EFT): Account Name: Progressive Martial Arts BSB: 064 133 Account: 1027 4248 Please include your Name and State as reference

REGISTRATION FORM SEMINAR DETAILS

TRAINING EQUIPMENT

MELBOURNE 8-9 DEC 2012 0415 131 812

ADELAIDE 6-7 DEC 2012 (08) 8212 5606

BRISBANE 29 NOV - 4 DEC(07) 3393 9329

DAN INOSANTOThe human encyclopedia of martial arts

2012 Australian Tour

PLEASE READ THE FOLLOWING CAREFULLY

1. I, the undersigned acknowledge that I have applied to voluntarily participate in the Dan Inosanto Seminar.

2. I am aware that participating in, learning, training and observing the practice of Jun Fan Gung Fu / Jeet Kuen / Maphilindo Silat / Filipino Martial Arts / Muay Thai and/or any other martial arts form that may be demonstrated, practiced or taught during the Dan Inosanto Seminar may be a dangerous undertaking and in undertaking any such activities I do so at my own risk.

3. I am also aware that it is a condition of admission to the Dan Inosanto Seminar, that the Nino Pilla International Academy of Martial Arts Pty Ltd, the Progressive Martial Arts Academy, their directors, instructors, members, servants or agents together with the Inosanto Academy, its directors, servants or agents and the Dan Inosanto Seminar Sponsors are absolved from any liability howsoever arising from injury or damage howsoever caused (whether fatal or otherwise) arising out of participating in the Dan Inosanto Seminar, including learning, training and observing the practice of Jun Fan Gung Fu / Jeet Kuen / Maphilindo Silat / Filipino Martial Arts / Muay Thai and/or any other martial arts form that may be demonstrated, practiced, taught or observed during the Dan Inosanto Seminar, or in any way whatsoever due to any negligent act, breach of duty, default and/or omission on the part of the Nino Pilla International Academy of Martial Arts Pty Ltd, the Progressive Martial Arts Academy, their directors, instructors, members, servants or agents, or on the part of the Inosanto Academy, its directors, instructors, members, servants or agents or on behalf of the Dan Inosanto Seminar Sponsors.

4. I am also aware that any person practicing, learning, training or observing Jun Fan Gung Fu / Jeet Kuen / Maphilindo Silat / Filipino Martial Arts / Muay Thai and/or participating, learning, training or observing any other form or martial arts or any activity whatsoever carried out during the Dan Inosanto Seminar are only allowed to do so on the distinct understanding that they do so at their own risk.

5. I acknowledge and am aware that participation in the Dan Inosanto Seminar may involve extremely strenuous physical activity and to consult my doctor if I have any physical condition or impairment that may prevent me from fully participating in the Dan Inosanto Seminar before commencing and undertaking such activity. I hereby represent that, to the best of my knowledge, I am in good physical health and condition, sufficient to undertake all activities and practices during the Dan Inosanto Seminar.

6. I understand that during the Dan Inosanto Seminar no photographs may be taken, and audio and video recording is strictly prohibited without prior express written consent of the Dan Inosanto Seminar Sponsors or Inosanto Academy. In addition, should I obtain prior written permission to take photographs; I agree that such photographs shall only be used by me and by no one else, for my own personal use and not for commercial gain or for any other purpose.

I, of (Your name)

(Address)

(Postcode)

(Home Phone) (Work Phone) (Mobile)

(Email) (Age)

DO HEREBY ACKNOWLEDGE that of my own free will and desire I submit my application to participate in the Dan Inosanto Seminar for instruction and training in martial arts (Jun Fan Gung Fu/Jeet Kuen/Maphilindo Silat/Filipino Martial Arts) activities mentioned above and that I have read and understood the warning in paragraph 5 above.

Signed by the said

(Signature or that of a parent/guardian if under 18years))

In the presence of

(Name of witness) (Signature of witness)

TERMS & CONDITIONS

BROUGHT TO YOU BY PROGRESSIVE MARTIAL ARTS ACADEMY INTERNATIONAL AND NINO PILLA INTERNATIONAL ACADEMY OF MARTIAL ARTS

The human encyclopedia of martial arts

An opportunity to meet and train with Guro Dan Inosanto.

A true pioneer of the Mixed Martial Arts and one of the most renown and sought after instructors in the business. Whether you are a beginner or a master in any of the martial arts, The Inosanto Tour will be sure to inspire.

Arts covered include: Jeet Kune Do, Filipino Martial Arts, Silat, Muay Thai and many more.