Welcome To The
Registration Form
1. Please fill out all information requested.
2. Return completed forms to: Mr. Barry’s Martial Arts, 12130 Antoine Dr. Suite H, Houston, Texas
77066.
3. Make checks payable to Mr. Barry’s Martial Arts and/or provide the correct credit card information.
4. All pre-registration forms must be received by Thursday, October 16, 2014.
To ensure your pre-registration forms are received, we suggest you mail your forms early and/or by
certified mail. THANK YOU FOR YOUR COOPERATION!
Name:
Rank:
Home Address:
Phone: (____) _____-__________
City:
State:
Zip:
Date of Birth: _______________ Age: _______ Sex: _______ Weight: ________
School Name:
2014 BMA Northwest Open
Karate Championship
Saturday October 18, 2014
New Location
Harvest Time Church
17770 Imperial Valley Dr.
Houston Texas 77060
New!
Check It Out!
Instructor:
Girls & Boys Divisions
Katas and Sparring
Ages 6 and up
School Address:
Events competing in:
Fighting
Kata
Specialty
Team Kata
Black Belt Weapons
_________ No. of Spectator Tickets @ $5.00 ea. (Pre-registration price) = $_____________
For information call:
Credit Card Information: Visa ____ M/C _____ Acct.# __________________________
Name on Account: ________________________________ Expiration Date: ___________
Barry Benton
(281)397-0566
Liability Waiver: I, the undersigned, do hereby voluntarily submit my application for attendance and
participation in the 2014 BMA Northwest Open Karate Championship, and I do hereby assume full
responsibility for any and all damages, injuries, or losses that I may incur or sustain while in attendance
or participation. I further waive all claims against the promoter, operator, or sponsor of the 2014 BMA
Northwest Open Karate Championship for any injuries and/or losses that I may sustain or incur.
If I have signed below as a GUARDIAN OR PARENT of the undersigned minor I furthermore
acknowledge that the waivers, releases and affirmations stated above apply to said minor I made on
behalf of said minor as the parent or legal guardian of said minor.
____________
Date
________________________________
Signature of Competitor
________________________________
Signature of Parent/Guardian
Women’s Black
Belt Sparring
(must be 4 competitors
in each division)
Men’s Black Belt
Sparring Divisions
 Light, Middle,
Heavy Weights, &
Executive Divisions 
(must be 4 competitors in
each division)
Mr. Barry Presents:
2014 BMA Northwest Open Karate Championship
October 18, 2014
Registration Begins 7:30 a.m.
Specialties Begin at 8:00 a.m.
Rules Meeting at 9:00 a.m.
Tournament Begins at 9:30 a.m.
Promoter: Mr. Barry Benton
Director: Bro. Jessie Gladney
Location:Harvest Time Church Houston, Texas 77014
Directions:
North
1. US-45 South toward HOUSTON.
2. Take the exit towards Greens Road.
3. Stay Turn Left on Greens Road.
4. Turn Left on Imperial Valley Drive.
5. Arrive at 17770 Imperial Drive.
South
Directions:
1. US-45 North toward Spring.
2. Take the exit toward Greens Road.
3. Stay right on Greens Road
4 Turn Left on to Imperial Drive.
5. Arrive at 17770 Imperial Drive
Men Light Wt Beg/Inter/Brown Belt/Black Belt
Men Md Wt Black Belt
Men Heavy Wt Beg/Inter/Brown Belt/Black Belt
Men Exec Beg/Inter/Brown Belt/Black Belt (L,H)
Women Beg/Inter/Brown Belt/Black Belt F/L
Women Exec Beg/Inter/Brown/ Black Belt .F/L
Black Belt Sr. Exec. Men (45+) (55+)
Black Belt
Grand Champion Sparring
Champion From Each Division
Must Compete to Qualify
Katas
Oct 17, 2013 and Later
$25.00 (Pre-Reg. Only)
$60.00
$15.00
$10.00
$5.00
Make checks payable to: Mr. Barry’s Martial Arts, send to: Mr. Barry’s Martial Arts, 12130
Antoine Dr. Suite H, Houston, Texas 77066
If paying by Visa/Master Card please provide the appropriate information on the
registration form provided. (Only cash will be accepted on October 17th) -No Refunds
SAFETY EQUIPMENT:
3 & 4 Year Sparring
5 & Under (Boys/Girls) Beg/Int
6-7 Girls Beg/Inter/Adv
6-7 Boys Beg/Inter/Adv
8-9 Girls Beg/Inter/Adv
8-9 Boys Beg/Inter/Adv
10-11 Girls Beg/Inter/Adv/Black Belt
10-11 Boys Beg/Inter/Adv/Black Belt
12-13 Girls Beg/Inter/Adv/Black Belt
12-13 Boys Beg/Inter/Adv/Black Belt
14-15 Girls Beg/Inter/Adv/Black Belt
14-15 Boys Beg/Inter/Adv/Black Belt
16-17 Girls Beg/Inter/Adv/Black Belt
16-17 Boys Beg/Inter/Adv/Black Belt
Light Weight=160lbs & Under
Middle Weight=161lbs-185 lbs
Heavy Weight=186lbs & Over
Entry Fees:
Event(s)
By Oct 16, 2014
3 & under Demonstration Div.
$25.00
Kata and/or Sparring
$50.00
Additional Division
$5.00
Spectators (Adult)
$5.00
Spectators (11 & under)
$5.00
Sparring
Foam-type hand, foot and shin pads. Mouthpiece and headgear. Groin Protectors (for
males) are mandatory for all sparring competitors
3 & Under (Boys/Girls) Demo
5 & Under (Boys/Girls)Beg/Int
6-7 Girls Beg/Inter/Adv
6-7 Boys Beg/Inter/Adv
8-9 Girls Beg/Inter/Adv
8-9 Boys Beg/Inter/Adv
10-11 Girls Beg/Inter/Adv/Black Belt
10-11 Boys Beg/Inter/Adv/Black Belt
12-13 Girls Beg/Inter/Adv/Black Belt
12-13 Boys Beg/Inter/Adv/Black Belt
14-15 Girls Beg/Inter/Adv/Black Belt
14-15 Boys Beg/Inter/Adv/Black Belt
16-17 Girls Beg/Inter/Adv/Black Belt
16-17 Boys Beg/Inter/Adv/Black Belt
Handicapable
Black Belt Sr. Exec. Men/Women (45+)
Black Belt Soft Style
Men Beg/Inter/Brown Belt/Black Belt
Men Exec Beg/Inter/Brown Belt/Black Belt
Women Beg/Inter/Brown Belt/Black Belt/
Women Exec Beg/Inter/Brown Belt/Black Belt
17 &Under Jr.Beg. Specialty
17 & Under, Inter Specialty
17 & Under, Brown Belt Specialty
17 & Under, Black Belt Specialty
Junior Team Kata (2 or More)
Adult Team Kata (2 or More)
Adult Self Defense
Adult Amateur Specialty
Black Belt Weapons
Black Belt Specialty
Traditional Jr BB/BB/Exec BB