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U.S. Open National Karate & Kung-Fu World Olympia Games
_________________ and the _________________
M.A.C. - Martial Arts Coalition / Tri-State National Tournaments
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U.S. National Karate & Kung-Fu Union
5960-L OGEECHEE ROAD
SAVANNAH, GA 31419
United States
ph: 912 - 920 - 3700
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N.K.K.U. OLYMPIA
Games 2 Person Teams Kata/Form Competition
Application Form
2 PERSON TEAM KATA/FORMS - COMPETITOR APPLICATION
( PLEASE PRINT TEAM NAME:____________________________________ )
WE WILL PARTICIPATE IN : TEAM KATA / FORMS - FEMALE and/or MALE
AGE GROUP All Belts : ( ) 3 - 5yr ( ) 6 - 9yr ( ) 10 - 13yr ( ) 14 - 17yr
( ) ADULTS under belts, ( ) ADULT BLACK BELTS
( 2 PERSON ( MALE and/or FEMALE ) TEAM KATA / FORMS )
YOUTH TEAMS UNDER 18yrs ADULT TEAMS 18yrs & Up ADULT TEAMS BLACK BELT
WHITE up to BLACK BELT WHITE up to BROWN BELT BLACK BELT
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( COMPETITOR # 1 ) LAST NAME:__________________ FIRST NAME:__________________ MIDDLE INT:____ ___________________________________________________________________________ STREET .................................CITY .................................STATE..................... ZIP
( ) MALE .....( ) FEMALE.............. ( ) I HAVE NO MEDICAL PROBLEMS
COMPETITOR #1 MEDICAL INFORMATION
MEDICAL PROBLEMS:
IF YOU HAVE INDICATED ANY MEDICAL DISORDERS YOU MUST ATTACH A DOCTOR’S RELEASE FORM STATING YOU ARE ABLE TO COMPETE.
COMPETITOR SIGNATURE: DATE:
************************************
( COMPETITOR # 2 ) LAST NAME:__________________ FIRST NAME:__________________ MIDDLE INT:____
___________________________________________________________________________ STREET .................................CITY .................................STATE..................... ZIP
( ) MALE .....( ) FEMALE.............. ( ) I HAVE NO MEDICAL PROBLEMS
COMPETITOR #2 MEDICAL INFORMATION
MEDICAL PROBLEMS:
IF YOU HAVE INDICATED ANY MEDICAL DISORDERS YOU MUST ATTACH A DOCTOR’S RELEASE FORM STATING YOU ARE ABLE TO COMPETE.
COMPETITOR SIGNATURE: DATE:
************************************
BY SIGNING ABOVE & BELOW, I/WE AGREE WITH AND STATE THAT, I/WE HAVE READ THE REGISTRATION PROCEDURE LISTED IN THIS FORM AND I/WE UNDERSTAND THAT THE ACCURACY, LEGIBILITY AND TIMELY RETURN OF THIS APPLICATION IS IMPERATIVE FOR MY PARTICIPATION IN THIS EVENT.
REMEMBER TO SIGN BELOW AND MAIL IT IN !!
I/We, hereby for our/myself, our/my executor(s) and heirs, forever and always agree to save and hold harmless the N.K.K.U., it’s Organization(s), officers, referees, judges, volunteers, members, event directors, promoters, competitors, facility owners, their respective agents, successors or anyone else involved in these events. For any injury and/or liability, that I/We may sustain, to include my way of travel to or from the Olympia Games, My direct or indirect involvement participating in this event. I/We willingly, with full understanding, that I/We agreed to enter and participate in this contact sport at my own risk. Therefore I’m responsible for my own injury insurance, and I agree to allow, without compensation, the unrestricted use of any photographs, films or videotapes of our/myself.
GUARDIAN SIGNATURE: DATE:
( GUARDIAN SIGNATURE NEEDED IF COMPETITORS ARE UNDER 18 YEARS OF AGE )
( 2 Person Team Registration Fee = $20 ) MONEY ORDER # _________________
Only Cash Will Be Accepted at the Competition Door !!! PAID AMOUNT $____________
RETURN TO : ( N.K.K.U. )
c/o OLYMPIA GAMES
P.O. BOX 18393 ......GARDEN CITY, GEORGIA 31408
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U.S.- N.K.K.U. Olympia Games 3 Person Sparring Application Form On-Line
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U.S. National Karate & Kung-Fu Union
5960-L OGEECHEE ROAD
SAVANNAH, GA 31419
United States
ph: 912 - 920 - 3700
nkku