Pre-Application 2015 - American Black Belt Academy

American Black Belt Academy 2015
Invitational Tae Kwon Do Tournament
Pre-Registration Form - DUE By 4/25/15
Please Print
Name:
Street Address:
City:
State:
Telephone Number: (
)
ZipCode:
Age on the Day of the Tournament:
Rank (please cir cle r ank or equivalent):
White
Yellow
Green
Blue
years.
Red
Name of Martial Arts School:
Martial Arts School:
Instructor Name:
The undersigned, in consideration of being allowed to watch, practice, compete of otherwise participate in this martial arts
tournament, and other related activities by American Black Belt Academy, does hereby irrevocably, personally and of their heirs
and assigns, release and waive any and all past, present and future claims, demands and causes of actions which the undersigned
now has or may have in the future against American Black Belt Academy and its officers, employees, agents, instructors and/or
assistant instructors as well as other participants and competitors, sponsors, promoters, tournament committee, tournament director,
volunteers, Oshkosh North High School, the city of Oshkosh for any and all past, present and/or future injuries sustained in any
manner including traveling to and from the tournament and tournament related activities. I also do hereby declare myself to be
physically sound to participate in this tournament and have trained for this event accordingly. I understand that any and all pictures
of me participating in this event may be used for publicity without compensation.
Date:
Signature
Date:
Mail Registration form to:
ABBA—P.O. Box 373—Oshkosh, WI 54903-0373
Signature of Parent or Guardian if
Participant is under 18 years of age
Tae Kwon Do Entry:
1, 2 or all 3 Events
=
Little Tigers Entry:
All Events =
$55
$40
Family Discounts available for more
than 2 family members:
2 @ $55.00 = $110.00
TKD ____@ $27.50 each = _____
Tiger_____@$20.00 each =_____
Please Enter Competition Categories Below.
(For example, a 16 Year-Old Blue 3 Belt competing in all three events:
F-14; B-14; S-14.)
F -
B -
S -
T igers