2007 MADISON TRADITIONAL KARATE TOURNAMENT
REGISTRATION FORM

To register: fill out (print or type), and return this application form with check made out to:
Madison Japanese Karate Club, c/o Vassil Peytchev, 2914 Interlaken Pass Road, Madison, WI 53719.
To avoid late registration fees, your form should be postmarked by October 29, 2007

Competitor's Name:                                                                                                          Phone:  (        )                          

Gender:   M / F   Age:              Rank:                                    e-mail:                                                                                  

Address:                                                                                      City:                                    State:             ZIP:               

Club Name:                                                            Instructor:                                            Phone: (        )                         

Address:                                                                                      City:                                    State:             ZIP:               

I would like to compete in the following categories (please check):

Ind. Kata           Team Kata           One Time Attack           Ind. Kumite           Team Kumite           En-Bu        

Early Registration Fee Postmarked By October 29, 2007

Late registraion is considered after October 29, with a $5.00 additional fee.

Single event $20, Two events $25, Three events or more $30

If you are competing in team events, you must enter your teammates' names:

Team Kata:       2.                                                                        3.                                                                    

Team Kumite:   2.                                                                        3.                                                                    

Team En-Bu:     2.                                                                    

Judging experience:  Y  /  N                                      months/years

Please enter total competition fee: $            

Release Form

I,                                                                  , and my heirs, in consideration for my participation in Recreational Sports Actities, hereby release the Board of Regents of the University of Wisconsin System, their officers, employees and agents, the tournament organizers, the Madison Japanese Karate Club, or anyone involved in any way with the tournament, from any liability for damage to, or loss of personal property, sickness and injury from whatever source, legal entanglements, imprisonment, death, loss of money, etc., which might occur while participating in any recreational and/or club sports activities. I understand the risks of such participation which include broken bones, strains, sprains and fatigue, to name but a few. I agree to abide by posted safety rules, adhere to the wearing of appropriate clothing and safety equipment and to conduct myself in a safe and responsible manner. I attest and verify that I am physically fit to participate in these activities. I further understand that the University provides no medical coverage for these activities. Should I incur medical expense, I understand that I am solely responsible for such costs. I also agree that any photos and videos taken of me during the tournament can be used by the tournament organizers for publicity or promotion without compensation to me.

                                                                                                              
Signature of Participant    (Parent/guardian if under 18 yrs) 		                                         
Date