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Member ID:   Password: 
REGISTRANT INFORMATION
While completing this form, do not use the browser BACK or FORWARD buttons; use only the buttons on this form. Fields in this color are required.
Closes at:  6 May 2019 11:59 PM US/Eastern
Competitor Information:

First name:
Last Name:
Date Of Birth: //
Gender:MaleFemale
Weight (in lbs):
(integer only)
Contact Information:

Email:
Address1:
Address2:
City:
State:

(If outside USA, enter below the state,
province, district, or area)
 
ZIP:
Country:
Day Tel:
Night Tel:
Academy, Gym, or Club:

Instructor(s):
Select
Academy
from list:
(If not on list, type name below)
Academy:
Address:
City:
State:

(If outside USA, enter below the state,
province, district, or area)
 
ZIP:
Country:
Telephone:
Emergency Contacts:

Name:
Phone:
T-shirt Size
Small   Medium   Large   XL   XXL  
REGISTERED CATEGORIES
Place a check mark next to each category for which you wish to register. All fields appearing under a label of this color are required for the category.
KIDS: 85.00 USD (Enable checkbox to register.)
Ages 5 to 14 years. Male and Females compete together. Age selection is age up until the day of tournament.
Rank  
Belt
Weight Class  
5-6 yrs
7-8 yrs
9-10 yrs
11-12 yrs
13-14 yrs (Teen)
Preferences  
When alone in division Move up in weight
Move up in age
JUVENILE: 85.00 USD (Enable checkbox to register.)
Ages 15-17 years. Separated by gender. Age selection is age up until the day of tournament.
Gender  
Group
Rank  
Belt
Weight Class  
Weight
Preferences  
When alone in division Move up in weight
Move to Adult
Adult Male: 110.00 USD (Enable checkbox to register.)
Adult Male born 2001 or before.
Rank  
Belt
Weight  
Class
Preferences  
When alone in divisoin Move up in weight
Master I Male: 110.00 USD (Enable checkbox to register.)
Master I Male born 1989 or before.
Rank  
Belt
Weight  
Class
Preferences  
When alone in division Move up in weight
Move down in age
Master II Male: 110.00 USD (Enable checkbox to register.)
Master II Male born 1979 or before.
Rank  
Belt
Weight  
Class
Preferences  
When alone in division Move up in weight
Move down in age
Adult Female: 110.00 USD (Enable checkbox to register.)
Rank  
Belt
Weight  
Class
Preferences  
When alone in division Move up in weight
Master Female: 110.00 USD (Enable checkbox to register.)
Master I Male born 1989 or before.
Rank  
Belt
Weight  
Class
Preferences  
When alone in division Move up in weight
INSTRUCTIONS
Carefully review your registration. You will not be entitled to a refund. If this registration is the 2nd family member who is registered and paid, then apply promo code "family" to get 10% off. If this is the 3rd or subsequent family member who is registered and paid, then apply promo code "family" to get 20% off. To qualify for the family discount, this registration must have the same last name and zip code as the registered family members.
REVIEW OF CATEGORIES
Promotion Code         Total Amount in USD
NOTES (Maximum of 70 Characters)
Payment Method
PayPal
(Current total is 0.00 USD )
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