American Black Belt Academy 2015 Invitational Tae Kwon Do Tournament Pre-Registration Form - DUE By 4/25/15 Please Print Name: Street Address: City: State: Telephone Number: ( ) ZipCode: Age on the Day of the Tournament: Rank (please cir cle r ank or equivalent): White Yellow Green Blue years. Red Name of Martial Arts School: Martial Arts School: Instructor Name: The undersigned, in consideration of being allowed to watch, practice, compete of otherwise participate in this martial arts tournament, and other related activities by American Black Belt Academy, does hereby irrevocably, personally and of their heirs and assigns, release and waive any and all past, present and future claims, demands and causes of actions which the undersigned now has or may have in the future against American Black Belt Academy and its officers, employees, agents, instructors and/or assistant instructors as well as other participants and competitors, sponsors, promoters, tournament committee, tournament director, volunteers, Oshkosh North High School, the city of Oshkosh for any and all past, present and/or future injuries sustained in any manner including traveling to and from the tournament and tournament related activities. I also do hereby declare myself to be physically sound to participate in this tournament and have trained for this event accordingly. I understand that any and all pictures of me participating in this event may be used for publicity without compensation. Date: Signature Date: Mail Registration form to: ABBA—P.O. Box 373—Oshkosh, WI 54903-0373 Signature of Parent or Guardian if Participant is under 18 years of age Tae Kwon Do Entry: 1, 2 or all 3 Events = Little Tigers Entry: All Events = $55 $40 Family Discounts available for more than 2 family members: 2 @ $55.00 = $110.00 TKD ____@ $27.50 each = _____ Tiger_____@$20.00 each =_____ Please Enter Competition Categories Below. (For example, a 16 Year-Old Blue 3 Belt competing in all three events: F-14; B-14; S-14.) F - B - S - T igers