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2018 Louisiana Pro-Am Online Registration

00002

2018 Louisiana Pro-Am Online Registration 00002
$50 In stock
Competitor First Name
Competitor Last Name
Competitor Age
Competitor Date of Birth
Competitor Rank
Competitor Street Address
Competitor City, State, Zip
Competitor Email
Competitor School Email
Is this your first USKA tournament? Yes (0) No (0)
Competitor Martial Art School
Competitor Martial Art Style
Competitor Instructor
Notice: this agreement contains indemnity and release provisions. In submitting said application, the undersigned hereby gives permission for the contestant to participate in said Louisiana Pro-Am to be held at Doyle Elementary School, Livingston, Louisiana on April 7th, 2018. Acting for myself, or as the parent or legal guardian for the contestant, I do hereby assume all risk of injury to said contestant while participating in and traveling both to and from said Louisiana Pro-Am, and acting for myself, my heirs, personal representatives and assigns, do hereby release the Livingston Parish School Board, Doyle Elementary School, Doyle High School, Donald Ray Effler, Jr., the tournament directors, United States Karate Alliance and associations, the officers, agents, employees and representatives of said organizations and any and all competitors and fellow participants, individually and collectively, from any liability (now and forever). As a parent or legal guardian, I agree to indemnify any such organization for any loss or expense by reason of any claim by child or ward. I agree (0)
Electronic Signature of Competitor or Guardian, if under 18 years old
Tournament Events (other than Forms and Sparring) Add Weapons to Forms & Sparring (5) Add on Chanbara to Forms & Sparring (5) Chanbara Only (-35) USKA Member Discount (-5)
USKA Membership Number (if member)
Events Participating In Sparring (0) Forms (0) Weapons (0) Chanbara (0)