Close Combat & Self Defense Seminar
With Grand Master Van Binh
President of the ITF-USA
February 20-21, 2010
Registration Form
Holiday INN
37-10 114 St. Corona , NY 11368
Phone (718) 651-2100
Name: Last Name:
Address:
City: State: Zip Code:
Phone: Age: D.O.B.
Rank: Black: Sex
e-mail Address:
School Name:
School Address:
School Phone #
Instructor:
Seminar Fee
PART AA $30.00
PART B
Level I $60.00 White Belts to Masters
Level II $90.00 Green Belts to Masters
Level III $120.00 Black Belt only
Level Iv $150.00 Masters, School Directors only
All checks must be in U.S. Funds to:
"Queens Taekwon-do Center"
89-18 Roosevelt Ave. Jackson Heights, NY. 11372
DAYLINE: FEBRUARY 12TH
I hereby submit my application to the Close Combat and Self Defense Seminar with GM Van Bihn and QTC or his officials .
I Agree to waive all claims against any persons connected with the Close Combat and Self Defense Seminar with
GM Van Bihn, QTC or his officials for injuries I may sustain and, likewise assume full responsibility for my actions in
connection with said events. I undertant that pictures of me participating in said events may be used forpublcity without
compensation
Signature: Date:
Parent or guardian if participant is under 18
1 Emanuel Bustos Queens Tkd 665723 30 30
2 Ricardo Bustos Queens Tkd 30
3 Albin Bernard Team USA 665696 30 30
1 Paul Byrne Byrne Tkd 665675 60 60
2 Domingo Polanco IITO 665692 60 60
3 Jerry Lamour IITO 665692 60 60
4 Luis Gil IITO 665292 60 60
5 Ramon Mateo IITO 665692 60 60
6 Owen corinaldi Knigts of TKd 665695 60 60
7 Llauger Castillo Puerto Rico 665693 60 60
8 Jose Zelaya Queens Tkd 665732 60 60
9 Juan C Garcia Queens Tkd 665698 60 60
10 Julio Carlos Queens Tkd 665691 60 60
11 Miguel Ramos Queens Tkd 665686 60 60
12 Ramon Sanchez Queens Tkd 665694 60 60
13 Robert Godoy Queens Tkd 665681 60 60
14 Stephanie Suarez Queens Tkd 60 60
15 Blake Winick Team USA 665696 60 60
16 Brandon Winick Team USA 665696 60 60
1 Joshua Buitrago Advantage Tkd 665688 90 90
2 Luis Mejia Advantage Tkd 665688 90 90
3 Matt Ulrich Advantage Tkd 665688 90 90
4 Pedro Candelario Inter TKD School 665687 90 90
5 Wainworth White Knigts of TKd 665697 90 90
6 Anderson Chang Original Tkd 665685 90 90
7 Minh Tuan Luong Original Tkd 665684 90 90
8 Federico Gonzalez Queens Tkd 665674 90 90
9 Gustavo Naranjo Queens Tkd 665690 90 90 90 Jose R
10 Jorge Coronel Queens Tkd 665689 90 90
11 Jose Rodriguez Queens Tkd 90
12 Ruben Suarez Queens Tkd 90 90 30 Ricardo B
13 Rupert Shoruder Queens Tkd 665668 90 90
14 Martha Hernandez The legacy 665691 90 90
15 Roger Benites The legacy 90 90 Roger
210
2400 2190
90
30
90
60
60
30
90
60
90
50
2840
Pasaje 275
Hotel 300
Lunch Friday 33
Rent of Hall 500
Pio pIo 100
Lunch Seminar 90
1298
Queens Taekwon-do Center
Informe del Seminario con GM Van Binh
Junio 15-16 2007
1 Joshua Buitrago Advantage Tkd $ 90.00
2 Luis Mejia Advantage Tkd $ 90.00
3 Matt Ulrich Advantage Tkd $ 90.00
4 Paul Byrne Byrne Tkd $ 60.00
5 Domingo Polanco IITO $ 60.00
6 Jerry Lamour IITO $ 60.00
7 Luis Gil IITO $ 60.00
8 Ramon Mateo IITO $ 60.00
9 Pedro Candelario Inter TKD School $ 90.00
10 Owen corinaldi Knigts of TKd $ 60.00
11 Wainworth White Knigts of TKd $ 90.00
12 Anderson Chang Original Tkd $ 90.00
13 Minh Tuan Luong Original Tkd $ 90.00
14 Llauger Castillo Puerto Rico $ 60.00
15 Emanuel Bustos Queens Tkd $ 30.00
16 Federico Gonzalez Queens Tkd $ 90.00
17 Gustavo Naranjo Queens Tkd $ 90.00
18 Jorge Coronel Queens Tkd $ 90.00
19 Jose Rodriguez Queens Tkd $ 90.00
20 Jose Zelaya Queens Tkd $ 60.00
21 Juan C Garcia Queens Tkd $ 60.00
22 Julio Carlos Queens Tkd $ 60.00
23 Miguel Ramos Queens Tkd $ 60.00
24 Ramon Sanchez Queens Tkd $ 60.00
25 Ricardo Bustos Queens Tkd $ 30.00
26 Robert Godoy Queens Tkd $ 60.00
27 Ruben Suarez Queens Tkd $ 90.00
28 Rupert Shoruder Queens Tkd $ 90.00
29 Stephanie Suarez Queens Tkd $ 60.00
30 Albin Bernard Team USA $ 30.00
31 Blake Winick Team USA $ 60.00
32 Brandon Winick Team USA $ 60.00
33 Martha Hernandez The legacy $ 90.00
34 Roger Benites The legacy $ 90.00
$ 2,400.00
ITF-USA 50% $ 1,200.00 ****
Host 25% $ 600.00
Instructor (GM Van Vinh)` 25% $ 600.00
Totals $ 2,400.00
*** Plain Ticket $ 275.00
Hotel $ 300.00
Hall $ 600.00
Food $ 295.00
$ 1,470.00