Tattershall School of Defence

Please read the entire form, check all options that apply, and include your name and address with your request.

Membership Application:
[ ] New Member
[ ] Renewal (Member Number ______________)
[ ] Change of Address
Name:_______________________________________________
Address:____________________________________________
___________________________________________
City:______________________ State:_____ Zip:________
Country: _______________________________
Date of Birth: Month:____ Day:____ Year:________
[ ] Male [ ] Female
Home Phone: (______)______-______
Work Phone: (______)______-______
Fax: (______)______-______
E-mail: ________________________________________

Membership:
Memberships run from Jan. 1- Dec. 31 and are renewable January 1st of each year. All paid members will be expected to renew in order to retain benefits of membership. An email reminder will be sent to the TSD mailing list.
[ ] Full year - $35 (for forms submitted Jan. 1st to June 31st)
[ ] Half year - $17.50 (for forms submitted July 1st to Dec. 31st)


Please specify your area(s) of interest:
[ ] Historical Fencing
[ ] Ancient Fencing
Primary Fencing School/Academy:
______________________________________________

Waiver of Liability:
You must sign this waiver of liability or membership will be null and void. Upon entering any event sponsored by the TSD, I agree to abide by the rules as published by the TSD. I understand and appreciate that participation in fencing carries a risk to me of serious injury, including permanent paralysis or death. I knowingly recognize, accept, and assume this risk and voluntarily release the TSD, their sponsors, event organizers, officials, affiliates, and participants from any liability.

______________________________________________ ____________________________
Fencer's Signature - Date
______________________________________________ ____________________________
Signature of Parent or Guardian - Date
(if fencer is under 18 years old)


Please mail your check or money order, payable to Jonathan Barber/Tattershall School of Defence, to:
Tattershall School of Defence
C/O Jonathan Barber
1217 East Gary Circle
Mesa, AZ 85203