Summer Super Brawl III Martial Arts Open

Registration Form
Name: Age : D.O.B.:
City: State: Zip:
Competitor Phone: Email:
Name of School:
Instructor's Name: Phone:
Gender: Male Female
Events: Kata Sparring Self-Defense Weapons Chanbarra
Belt Rank: Division: Shirt Size:

I agree to assume full responsibility for any and all damages, injuries or losses that I may sustain or incur, if any, while attending or participating/competing. I hereby waive all claims against the promoters, operators, sponsors, advertisers, tournament agents or the Professional Karate Commission (PKC). I also hereby waive any compensation whatsoever, for the use of photos, movies, media coverage, etc.. utilized by those associated with this event at any time. I fully understand that any medical treatment given to me will be of First-Aid treatment only.

I have read and agree with the above terms and conditions

Spectating Adults: 
x $10
Spectating Kids:   
x $6
Event T-Shirt:     
x $15
Event Patch:       
x $10
Item Price
Tournament Entry $50.00
Processing Fee $2.00
Total $52.00

When paying online, print receipt and registration form. Fill out registration form and bring both with you to the event. Do not fax or mail when paying online.

Make sure the above form is filled correctly. Incomplete and incorrect forms cannot be processed.

Birth Certificates are mandatory upon request in all divisions