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Tournament Registration

 
 
 

Online Pre-Registration Form

Click here for printable registration form (For postal mail in payments only)
(For online registration fill out the form below and submit after payment)

EARLY BIRD: Pre-Registration must be received by December 1, 2009
ADVANCED: Pre-Registration must be received by January 24, 2010
Friday: $30.00 for one or all events Saturday: $45.00 for one or all events
Item Name: Friday Night Registration
Item Number:
Price: $30.00
Item Name: Saturday Registration
Item Number:
Price: $45.00
Item Name: Adult Spectator
Item Number:
Price: $10.00
 Item Name: Child Spectator
Item Number:
Price: $8.00
Name
Address 
City
State
Zip
Phone
School
E-Mail    
Age
Belt
Date       
Instructor
PKC#


Enter your division number in spaces below that you will be entering

Friday Competition

3 Person Ippon Team
2-4 Person Team Form
Ippon Kumite
Musical Kata
3 Person Sparring        


Saturday Competition

Self Defense
Weapons
Forms
Fighting


Waiver: In consideration for the acceptance of this application which is voluntarily submitted be me, I intend to be legally bound hereby for myself, executors and administrators and do waive and release any and all rights and claims for physical, mental, and emotional damages, or other claims, which I might have against King Cobra Karate Inc., Avalon Hotel and any and all other connected with this tournament for any and all injuries suffered, damages, actions, or cause of actions, whatsoever, to my person or property.

Competitor Signature


Please Note: If under 18 years of age, this release and consent form must be signed by the competitor's parent or legal guardian. (Electronic mail will count and serve as real signature on this form)

Parent or Guardian Signature
E-mail Address


Select T-shirt size below (Sorry: No XXL Sizes Available)

 



  

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