Page 5 - Brochure

PRE-REGISTRATIONS must be postmarked by September 1, 2020 and received by September 17, 2020
including full and complete entry fees for pre-registration rate to be honored. Late and incomplete payments will be assessed the At
the Door registration rate for the entire registration.
PLEASE PRINT LEGIBLY
PLAYER REGISTRATION (Incomplete forms will not be accepted)
Competition
Name: M F Birthdate: Age: ______

Address:
(street, city, st, zip)

Phone: Novice Intermediate Advanced Black Belt WT:

E-Mail Address: Registration Total: $________

School / Team Name: Phone:

City: ST: Zip: E-Mail Address:

PLEASE ENTER DIVISION NUMBERS

Forms - Traditional: FT-____ Forms - Creative: FC-____ Weapons - Traditional: WT-____ Weapons - Creative: WC-____

Sparring - Point: SP-____ Sparring - Flag: SF-____ Sparring - Open: SO-____ Sparring - Kyokushin: SK-____
Self Defense: SD-____ Team Forms: TF-____ # of Divs Entering:

REGISTRATION CALCULATION

: 1 Div=$60.00 : 2 Div=$110 : 3 Div=$150 : 4 Div=$180 : 5 Div=$200 : 6 Div=$210 : 7 Div=$215
Discounts: 6/1-7/15: 50% off 7/16-8/15: 50% off 8/16-9/17: 40% off

Make checks payable to: Kiai Martial Arts & City of Destiny Classic in the Note Section Registration Total: $________

TERMS AND CONDITIONS

Please read and agree to the Terms and Conditions in order to participate in the 2020 City of Destiny Classic.

Full payment must be received to be considered pre-registered. If full payment is not received, registrant will be subject to
the current rate at time of complete payment. Early Bird and Pre-Registration benefits will also be excluded until full
payment is made and only those benefits which apply at time of payment will be applied.

I agree that I am 18 years or older or the Parent/Guardian of the registrant, agreeing to terms on his/her behalf. By agreeing
to these terms, I hereby waive all claims against any and all persons involved with the City of Destiny Classic for any injuries
which may occur before and during my participation in the competition. I also assume full responsibility for my actions
during and in connection with said activities. I will abide by all rules and safe practices of martial arts competition.
Any misconduct from competitors or spectators can result in disqualification or ejection from the tournament. I agree that
my performance and/or attendance at these activities may be filmed and/or recorded with or without my consent, and that
the City of Destiny Classic and its associates may use my name, likeness, voices, poses, pictures and biographical data
concerning me, fully or in part in any language with or without other material, anywhere by means known or devised: and I
waive my compensation there of. Tournament entry, Spectator, and Coaching fees are non-refundable.

Signature: Print: Date:
If under 18 years of age - parent or legal guardian