Registration Form

For Credit Card payment: Submit the form below and we will sent you an online invoice to pay.

For Check or Money Order payments, please mail signed waiver and pre-registration form with your payment (payable to):
Shihan Roxanne Marcum
1820 Paradise Rd
Orrville, Ohio 44667

If you have any questions about your registration, please call Shihan Roxanne Marcum 330-682-5266 or e-mail

Pre-registration forms must be received by September 22, 2018.

Black Belt Dan Rank
Time in Training
Home Phone
Cell Phone
Address City State Zip
Instructor's Name
Martial Art's School and Phone

Seminars I would like to attend:
Before 9/15: Morning or Afternoon Seminars $25 each, All Seminars for$40
After 9/15: Morning or Afternoon Seminars $35 each, All Seminars for $60

Sunday October 7 Master Toby Cooling Seminars
Pre-registration and Walk-in same price: $20 for 1 / $35 for both

Divisions. Please fill in which events in which you would like to participate. Thanks! Remember, pre-registration is $55.00 and after 9/15/2018 the cost is $65.00!

Waiver: I understand that the practice of Martial Arts, and specifically, seminar and tournament competition, is inherently a contact sport, and as such, I know that physical injury can occur. As consideration for being allowed to compete in this Isshinryu tournament, I hereby assume all responsibility for and all risk of damage or injury that may occur as a participant in the symposium and tournament. Specifically I agree to release and will hold harmless and fully indemnify for any claims which might arise, the Isshinryu Karate Academy, Kent Karate & Family Fitness, and Marcum's Martial Arts Academy the injury which may occur from my participation in the All Isshinryu National Championship & Masters Symposium. I fully understand that any medical treatment given to me will be First Aid treatment only. By signing this document, I acknowledge that I have read the rules and agree to abide by them and assume fully responsibility for any and all of my actions during this tournament. If under the age of 18 years, a parent or legal guardian must also sign the waiver.