JPJKD Event Registration

Jerry Poteet’s Jeet Kune Do Event Registration Form

Fill out the registration form below to register for an event
or for more information, please email info@jpjkd.com
(Prepare for an event by signing up for our Online JKD eAcademy)

Select JKD Event:*
Name:*
E-mail:*
Address:*
Phone Number:*
Verification:

BY SUBMITTING THIS FORM YOU CERTIFY YOU ARE AT LEAST 18 YEARS OLD, AND ARE REASONABLY FIT AND IN GOOD HEALTH TO PARTICIPATE IN ALL ACTIVITIES ASSOCIATED WITH THIS EVENT. YOU UNDERSTAND THAT YOU WILL RE REQUIRED TO EXECUTE A GENERAL RELEASE AND WAIVER FORM PRIOR TO THE EVENT AS A CONDITION OF YOUR PARTICIPATION.
I agree to being contacted about my application and acknowledge that all the information that I have provided is accurate. I also acknowledge that this form is an application and does not represent acceptance by Jerry Poteet’s JKD Association of registration for the event(s) listed on this page. I understand that I will be contacted to determine my eligibility to be able to register for the event(s) on this page.
I understand that if eligible, I must pay for the event in full in advance to secure my spot.
For assistance, please email info@jpjkd.com
(Prepare for an event by signing up for our Online JKD eAcademy)