SDS JKDA MEMBERSHIP APP

Jeet Kune Do Association                   

Membership Application

• Professor Gary Dill, Founder, Chief Instructor  
• Master Sifu Jill Hernandez, Executive Director

Name____________________________________________________________________________________________

Email_____________________________________________________(Please print clearly for JKD Newsletter.)

Mailing Address__________________________________________________________________________________

Telephone________________________________________________________Age____________________________

Occupation_______________________________________________________________________________________                                          

• List martial arts experience on back of application. (Or on another page for email.)

                   (style, rank, years of experience)(any JKD training)

• List any military and/or law enforcement experience on back. 

WAIVER

I understand that I am enrolling in a martial arts training program which incorporates physical contact training, and by the nature of this program there is a possibility of injury.  In case of my injury I agree to release Professor Gary Dill, Master Jill Hernandez, and any of his staff and / or instructors from any liabilities and claims that may result from such injuries.  I agree to follow the rules and policies of the Jeet Kune Do Association and Self-Defense Systems International Martial Arts Federation.  I understand that I will not be involved in any activity that will bring discredit or embarrassment to my school, instructor, or the JKD Association.  I may terminate my training at any time I desire.  My membership and training is considered “at will” and my membership and training may be terminated at any time by my instructor and/or the JKD Association.  The information provided in this application is true and correct, and that this is my signature below (or my parent or guardian if a minor). 

___________________________________________________                                      ___________________

Signature                                                                                                                  Date

Professor Gary Dill, 1st Generation JKD Student, Oakland CA (Bruce Lee- Chief Instructor, James Lee-instructor)

Master Sifu Jill Hernandez, 2nd Generation Student, Executive Director - Jeet Kune Do Association 

www.jkd-garydill.com     email: pdilljkd@aol.com

Prof. G.W. Dill

PO Box 3396

Bartlesville, OK  74006  

Chief Sifu / Professor Gary Dill     

Oakland to Oklahoma......50 years JKD experience   (1971 - Present)