
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!