Registration2 – USAMA Arizona State Championships

Please Fill out and submit a separate Registration Form for each competitor. Once you press the SUBMIT Button at the bottom of the form, you will be routed to the payment page, which may take a minute or so.

First Name^*

Last Name^*

Age^*

Gender^*

Male
Female

Cell Phone #^*

Home Phone #^*

Address

Email Address^*

Alternate Email

Martial Arts School^*

Instructor's Name^*

Rank^*

Style^*

Time in Martial Arts^*

USAMA #

Enroll me to compete in the following Tournament Events^*

Select the events you will participate in

Tournament Entry Fees are as follows:

1 Event = $40.......... 2 Events = $75 .......... 3 Events = $90 .......... 4 Events = $105 .......... 5 Events = $120

* Prices reflect a $10 discount applied for registrations processed by Friday 10/25*

# Tournament Events Selected Above (***$5 discount applied)^*

Spectator Tickets (for Parents, Family and/or Friends)

Would you like to purchase any Raffle Tickets?

Waiver Release^*

* I understand that karate is a contact sport. I am aware that I am participating in an activity which involves physical contact and injuries may occur which may potentially involve Covid & other virus contact, bodily harm or even death and do so at my own risk. I waive any claim or cause of action I may have against the promoters of the tournament, Rising Sun Martial Arts LLC, Tim Vandenover, the USAMA National Team, and the U.S. Association of
Martial Artists Inc., that may arise out of my participation in this tournament &/or activities. I further agree to indemnify and hold harmless the promoters, Tim Vandenover, the USAMA National Team, and the U.S. Association of Martial Artists Inc., for any injuries, sickness, Covid & other viruses, or damages which may arise due to my participation in this tournament. I state that I do not suffer from Covid or any symptoms, and/or physical conditions, and/or mental conditions which may affect my participation in this tournament &/or activities. I further agree to conduct myself in a sportsmanlike and safemanner and understand if I fail to do so, I may be disqualified from the tournament and not entitled to a refund. I hereby grant the U.S. Association of Martial Artists, Inc. "USAMA") permission to use my likeness in a photograph, video, or other digital media (photos") in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of the USAMA. I agree to comply with the local public health orders. I also hereby give permission to medical personnel to administer First Aid or Emergency Treatment if, in their opinion, it becomes necessary.

I Accept Waiver Release

Electronic Signature^*

* If competitor is under 18 years, signature of parent or guardian is required

Comments and/or Other Information

Processing fee INCLUDED in Total Price

Select a payment method^*

Tournament Entry Fees are as follows:

*** Prices reflect a $10 discount applied for registrations processed by Friday 10/25***

*Processing fee INCLUDED in Total Price*

* Prices reflect a $10 discount applied for registrations processed by Friday 10/25*

Processing fee INCLUDED in Total Price