30th Annual Southern Karate Championships

2009 on-line Registration Form

New Date -- October 31st!

On-line registration ENDS Thursday, Oct. 29th at 8:00 pm, so register today!!!!!!!!!!!!!!

For all the tournament details or a hard copy of the registration form go HERE.

Online payments are easy because we accept:

Please fill out EVERYTHING on the form pertaining to the competitor. To not do so, may cause the competitor to be entered in the wrong division.

***Please use the TAB key to go from one entry box to another. DO NOT use the ENTER or RETURN key to navigate through the entry boxes.***

Please provide the following contact information:

Competitor's First Name
Competitor's Last Name
Name on Paypal Account	* Required Field- Leaving this field blank will ensure a BAD registration
Paypal Email	* Required Field- Leaving this field blank will ensure a BAD registration

Phone
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Instructor

Please describe yourself:

Date of Birth

Sex Male Female

Height

Weight

Rank

Online Pre-registration Prices are as follows: 1 or 2 divisions = $40

Current AKBBA members = $35

Additional Events =$5 each

Beginner "Demo" Division $30 -- $15 if competing in addition to regular Forms/Sparring

AOK Divisions

Kata divisions :

Kata divisions continued:

Team name, for doing Team Kata ONLY (Everyone entering team kata must register separately, and include their team name.)

Sparring division entered today: NOTE: Only one sparring division is allowed per person.

Spectators- adults

Pre-registration

@ $8
Spectators- children: (5-12 yrs.) (4 yrs. & under-FREE)

Pre-registration

@ $4
Special requests, or if the competitor's last name is different from the person that is paying by Paypal:

By submitting this form, I do hereby voluntarily enter my application for participation in the Southern Championships 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. I waive all claims for/or against the promoters, or operators, or sponsors of the Southern Championships, 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 of illness, which might prohibit competition. I consent that any picture furnished by me or any picture taken of me in connection with the Southern Championships can be used for publicity, promotion or television show, and I waive compensation in regards thereto. If under 18, this release and consent is to be signed by parent or guardian. I further agree to abide by the rules of the tournament and the final decisions of the officials. I certify that the above information is correct and accurate to the best of my knowledge. The Producer (s) of the Southern Championships reserve the right to refuse entry to anyone.

If the competitor is under 18 yrs. of age, a parent or guardian must fill in the box below with his/her name and date. Note: You may also be asked to sign the form at the Southern Championships.

Name of Parent or Guardian (if under 18 yrs.)

Please keep track of your totals, BEFORE YOU SUBMIT THIS FORM. You MUST be able to provide Paypal with the correct totals when paying. For multiple entries in the same household, use your "Back" button on your browser to bring this form back, then re-enter the appropriate information and divisions for competitor #2. A thank you message will appear saying your entry has been received each time this form is submitted.

After submitting this form, you MUST then pay by PAYPAL by hitting the "PAY NOW" button on the "THANK YOU" page that will come up when this form is submitted. Failure to do so will negate your entry.

Paypal will accept credit cards, payments from your bank account, or Paypal balances. It is secure and easy to do, but you must be registered, or register with Paypal first, which is FREE. Paypal will then send you a receipt by email, which we suggest you print and bring to the Southern Championships for confirmation of payment.

Please click form only ONCE. Sometimes there is a delay, depending on conditions.

Don't forget to pay by Paypal after submitting your entry!!!!!!!!!!!!!!

It is suggested you print out this form and bring it with you to tournament registration.

Date of Birth
Sex	Male	Female
Height
Weight

30th Annual Southern Karate Championships

2009 on-line Registration Form

Copyright © 2009 Barry Guimbellot. All rights reserved. Revised: January 02, 2010

Copyright © 2009 Barry Guimbellot. All rights reserved.
Revised: January 02, 2010