MAIL MAIL REGISTRATION TO KKIA (TYPE IN INFO AND PRINT)
KKIA
1205 N Melrose Dr, Suit., A
Vista, CA 92083
(760) 815-1254
shorinkansandiego@yahoo.com
NAME:
MIDDLE:
STATE:
ZIP:
LAST NAME:
ADDRESS:
TELEPHONE NUMBER:
E-MAIL:
SCHOOL NAME:
SCHOOL INSTRUCTOR:
SCHOOL ADDRESS:
SCHOOL EMAIL:
SCHOOL TELEPHONE:
BELT COLOR:
M/F
AGE:
PLEASE PLACE  YOUR AGE NEXT TO THE DIVISION YOU WISH YOU COMPETE INN
AND A
N/A IN THE DIVISIONS YOU WILL NOT COMPETE INN.
SPARRING:
KATA:
WEAPON:
SPECTATOR:
$
1ST DIVISION $30 Before August 10th $25.00
COST FOR 1 DIVISIONS IS $25.00 After August 10th
$25.00
COST FOR A 2ND IS ADDITIONAL $5.00   
COST FOR A 3RD DIVISION IS ADDITIONAL $5.00
SPECTATORS IS $3.00 EACH
(FREE UNDER AGES 6)
$
2ND DIVISION $5.00
3RD DIVISION $5.00
$
SPECTATOR: AMOUNT X $0 EACH
ADD THE $ AMOUNT ON THE RIGHT. IF NOT ENTER A
DIVISION TYPE
N/A DON'T FORGET YOUR TOTAL
$
$
TOTAL:
Your Name:
As it appears on Credit
Card
First Name
Last Name
Credit Card Number:
VISA or MASTER CARD
Expiration:
3 Digit Security Code:
Behind Card
$
TOTAL:
Hold Harmless Waiver and Release

I understand that karate is a contact sport. As such, I am aware that I am participating in an activity that involves physical
contact and injuries may occur, which may potentially involve great bodily harm or even death and I do so at my own risk. I
waive any claim or cause of action I may have against the promoters of the event, the judges, and other competitors,
and any other affiliated or instructor or entities. I further agree not to indemnify and hold harmless to the promoters, judges,
and any other affiliated in instructor or entities from any and all causes of action or claims which may arise from another
competitor due to my participation or actions in this event. I state that I do not suffer from any physical and mental conditions,
which may affect my participation in this event. I further agree to conduct myself in a sportsmanlike manner and understand
that if I fail to do so, I may be ask to leave from the event and not entitled to a refund. Placing your name bellow will serve as
an electronic
SIGNATURE: Please type name.
Comments:
Enter starting street address:

City, State or Zipcode:
EVENT DIRECTIONS:  1205 N Melrose Dr, Vista Ca 92083
TOURNAMENT ONLINE
REGISTRATION
AGES 4
AND UP
Calander