Ocean Nationals Sept 18, 2010

On-Line Registrations Form

Deadline is Sept 14,2010

Please provide the following contact information:
First name Last name
Address
City, State Zip
Rank Age
DateOfBirth Sex Male Female
Height Weight
Home Phone Work Phone
E-mail    
            Please provide the following contact information:
Club Name
Instructor's Name
Street address
City/State/Zip
Club Phone
Club E-mail
           Please provide the following ordering information:
QTY DESCRIPTION (ONLINE will be closed on Sept 14th at midnite! ) 
 Number of  Events Entering ( Your card will be billed $45.00 for 2 events and $10.00 for each additional )
Number of SPECTATOR (Your card will be billed for $10 for each spectator)
Number of Ocean Nationals T-Shirt (Your card will be billed for $15 for each T-shirt)
TOTAL DOLLAR AMOUNT  
 
 
 
Please enter the CODE NUMBER OF DIVISIONS you are competing in. Number listed above
Example:  W-1,  F-4,  F-22, et...  
 
1st Event 2nd Event 3rd event 4th Event
 
 
SPECIAL COMMENTS IF ANY:
 
 

LIABILITY WAIVER. I do hereby voluntarily submit my application for participation in the "Ocean Nationals" martial arts tournament and hereby assume full responsibility for any and all damages, injuries, or losses that I may sustain or incur, if any, while attending or participating and I waive all claims for/or against the promoters, or operator, or sponsors of said Martial Arts Tournament, individually or otherwise for any claims for injuries that I may sustain. I fully understand that I am entering such competition at my own risk, and that any medical treatment given to me will be of a first aid treatment type only. I declare that I am free of any physical defects or illness that might prohibit competition. I consent that any picture furnished by me or any picture taken of me in connection with the tournament can be used for publicity, promotion, or television shows, and I waive compensation in regards thereto, if under 18, this release and consent must be signed by parent or guardian. I further agree to abide by the rules of the tournament and the final decision of the officials. I certify that the above information is current and accurate to the best of my knowledge. If I have signed below a GUARDIAN or PARENT of the undersigned minor, I furthermore acknowledge that the waivers, releases, and affirmations stated above apply to said minor I made such in behalf of said minor as the parent or legal guardian of said minor.  I furthermore agree that by submitting this form that I accept all of the above conditions.  I also understand that this is an non-refundable transaction.
 
We only accepted Paypay payment!  PLEASE READ CAREFULLY!   
 
Very Important!  You must complete and click the "SUBMIT FORM" button (Located Below) before using Paypal.  Check for any errors.  Once you click the submit button, it will ask you to click the "Return to Form" to return to this page.  Proceed and click the "PayPal" below and send payment to TKOKick@yahoo.com   
 
  

        Credit or debit card through PayPal
NOTE: We do not send confirmation #.  Your Paypal payment is your verification and we will match it to your online registration. Please bring   it with you on day of event as a proof of payment. THANK YOU!

 TKO Karate
Copyright © 1999 TKO. All rights reserved.
Revised: August 31, 2010 .