2010 ITKA International Sima and Zahra Memorial Tournament
International Traditional Karate Association World Friendship Tournament
March 27th-28th
Name: _________________________ Male/Female: ______________
Address: ___________________________________Phone: ________________
City: ____________ State: ______ Zip: _____Country: _________ Email: ______________
Work Phone: ______________________ Fax Number:______________
Dojo: _________________ Instructor: _____________________ Birthday: ______ Age _____
Rank(kyu): ___________ Height: _______ Weight _______ LBS. ____ KG. ____ (check one)
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Saturday, March 27th events: Seminar and WKF Kumite Seminar will be held
at the Main Dojo 5945 W. Irving Park Road Chicago, IL 60634
12:00 PM Kobudo - 1:00 PM Kata - 2:00 PM Kumite
3:30 to 6:30 PM WKF Kumite Judges & Referee Course Exam & Certification
7:00 PM Dinner pay your own
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1 Hour
Seminar $50
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2 Hour Seminar
$ 95
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3 Hour Seminar $130 |
WKF Kumite Seminar and Referee Course Certification
3 Hour Saturday
2 hour Sunday $110
All Seminars, Including Judges' Seminar $225
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□ I am attending Kata □ Kobudo □ Kumite
□ WKF Kumite Referee Course
□ 3 Hour Seminar KOBUDO, KATA, Kumite $140
Tournament Sunday, March 28th at Wright College
If you register by March 1st, 2010, take $5 off. Add $10 after March 10th
Family Discount: Families of two or more may subtract $10 per application.
One Event $65 Two Events $75 Three or more events $85
Circle the Appropriate Categories Below: I am competing in the following:
Ages 7 and under Kobudo
Ages 8-9 10th & 9th Kyu Individual Kata
Ages 10-12 8th & 7th Kyu Individual Kumite
Ages 13-15 6th, 5th, 4th Kyu Team Kumite (Adults only)
Ages 16-17 3rd, 2nd, 1st Kyu Team Kata
Ages 18-44 1st Dan and up Kihon (10th-6th kyu only)
Ages 45 & up
*Events/Divisions/Categories/Schedule are subject to change.*
Team Competition List Team Mates Below (4th competitor is alternative):
Team Kata: 1) ______________________ 2) ____________________ 3) ______________ 4th: _________________
Team Kumite: 1) ____________________ 2) _____________________3) _______________
4th: _______________________
Amount Due NO REFUNDS
Whereas I, ____________, am applying for (Minor name here) ____________ to enter the ________ (date) Tournament Understanding the risks of injury, damages, or losses involved, hereby waive and forever release the ITKA, Wright College, all Clubs, and parties associated with aforementioned from any and all responsibility resulting in personal injury, concussion, broken bones, death, loss or damage to personal property or actions which might be taken against them in connection with my participation in said events. I waive full financial obligations incurred for medical, hospital and other expenses related to injury or death resulting from my participation in tournament or in traveling to, from or about the tournament. I release and hold harmless the ITKA, JKAI, Wright College, and all parties, their liability and claims for those expenses described above. I sign this release fully understanding the risk in my participation in said tournament or in tournament release activities. I further have read the foregoing and fully understand the contents of this release of indemnity.
I understand and assume all risks involved in participation in the tournament and tournament activities.
Signature: ____________________________ Date: __________
Signature of Guardian (under 18): _________________
Please make all checks payable to: ITKA Mail to: ITKA Headquarters 5945 W. Irving Park Road Chicago, IL 60634
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