REGISTRATION FORM

 

NAME:___________________________________

AGE:______   D.O.B. ___________ M____   F____

 

ADDRESS (PERSONAL OR SCHOOL)

_______________________________________

_______________________________________

 

CITY_____________________________

STATE_________   ZIP_________

PHONE: (          )_____________________

INSTRUCTOR NAME:_____________________

EMAIL: __________________________________

STUDIO NAME___________________________

I the under signee, agree and understand, The ALL STARS KARATE NATIONALS martial arts tournament is a contact event and that serious injury, maiming or death can occur. Myself, Son/Daughter is in good physical condition and is willing and able to compete in The ALL STARS KARATE NATIONALS.  I will not hold Norene Price/ Anthony Price, Priceless Martial Arts Academy, Referees, Judges, Competitors, the facilities in which said event is held or anyone else affiliated with The ALL STARS KARATE NATIONALS, liable in case of any injury to Myself, Son/ Daughter (Competitor). 

SIGNATURE______________________________

DATE_______________

SIGNATURE or GUARDIAN (IF UNDER 18 YEARS) _________________________________

DATE_______________

ENTRY FEE

 $60.00 at Door / $50.00 Pre-Registration 

                                                                   

Pre-Registration Must be Post Marked by August 10th, 2019

                                                             

Please check the event(s) in which you will be competing:

                                             

Beg____      Int____      Adv____      Black Belt____

Weapons____  Forms____  Fighting____

All checks payable to Priceless Martial Arts

Mail to 11271 Hanover Rd, Cincinnati, Ohio 45240

                                                                                   

NO CHECKS AFTER August 10th, 2019

(Bounced Check Fee of ($35.00) Will be Passed to YOU!)   ABSOLUTELY NO REFUNDS!

© 2019 Copyright PricelessMartialArts.com  All Rights Reserved 

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