knyREG_pAGE3 copy

KING OF NEW YORK MARTIAL ARTS TOURNAMENT- TO REGISTER ONLINE GO TO NEXTLEVELMA.COM
COMPETITOR NAME:___________________________________________________________ AGE:_____________ D.O.B:_____________________________
ADDRESS:________________________________________________________ CITY:___________________ STATE:_________ ZIP CODE:______________
TELEPHONE:________________________________________________________ EMAIL:______________________________________________________________
SCHOOL NAME:___________________________________________ RANK:_____________________ INSTRUCTOR:_________________________________
SCHOOL ADDRESS:______________________________________________ CITY:___________________ STATE:_________ ZIP CODE:______________
TELEPHONE:_________________________________________________________ EMAIL:____________________________________________________________
BLACK BELT DIVISIONS
WEAPONS
 9 & UN TRAD (BOYS/GIRLS)
 9 & UN OPEN (BOYS/GIRLS)
 10-11 TRAD (BOYS/GIRLS)
 10-11 OPEN (BOYS/GIRLS)
 12-13 TRAD (BOYS/GIRLS)
 12-13 OPEN (BOYS/GIRLS)
 14-15 TRAD (BOYS/GIRLS)
 14-15 OPEN (BOYS/GIRLS)
 16-17 TRAD (BOYS/GIRLS)
 16-17 OPEN (BOYS/GIRLS)
FORMS
 9 & UN TRAD (BOYS/GIRLS)
 9 & UN OPEN (BOYS/GIRLS)
 10-11 TRAD (BOYS/GIRLS)
 10-11 OPEN (BOYS/GIRLS)
 12-13 TRAD (BOYS/GIRLS)
 12-13 OPEN (BOYS/GIRLS)
 14-15 TRAD (BOYS/GIRLS)
 14-15 OPEN (BOYS/GIRLS)
 16-17 TRAD (BOYS/GIRLS)
 16-17 OPEN (BOYS/GIRLS)
WEAPONS
 18-29 BEG MEN
 18-29 BEG WOMEN
 18-29 INTER MEN
 18-29 INTER WOMEN
 18-29 ADV MEN
 18-29 ADV WOMEN
 30-39 BEG MEN
 30-39 BEG WOMEN
 30-39 INTER MEN
 30-39 INT ER WOMEN
 30-39 ADV MEN
 30-39 ADV WOMEN
 40-49 BEG MEN
 40-49 BEG WOMEN
 40-49 INTER MEN
 40-49 INTER WOMEN
 40-49 ADV MEN
 40 -49 ADV WOMEN
 50 + ALL RANKS MEN
 50 + ALL RANKS WOMEN
FORMS
 18-29 BEG MEN
 18-29 BEG WOMEN
 18-29 INTER MEN
 18-29 INTER WOMEN
 18-29 ADV MEN
 18-29 ADV WOMEN
 30-39 BEG MEN
 30-39 BEG WOMEN
 30-39 INTER MEN
 30-39 INT ER WOMEN
 30-39 ADV MEN
 30-39 ADV WOMEN
 40-49 BEG MEN
 40-49 BEG WOMEN
 40-49 INTER MEN
 40-49 INTER WOMEN
 40-49 ADV MEN
 40-49 ADV WOMEN
 50 + ALL RANKS MEN
 50 + ALL RANKS WOMEN
FIGHTING
 9 & UNDER (BOYS)
 9 & UNDER (GIRLS)
 10-11 (BOYS)
 10-11 (GIRLS)
 12-13 BOYS
 12-13 GIRLS
 14-15 BOYS
 14-15 GIRLS
 16-17 BOYS
 16-17 GIRLS
WEAPONS
 18-29 TRAD MEN
 18-29 OPEN MEN
 18-29 TRAD WOMEN
 18-29 OPEN WOMEN
 30-39 MEN
 30-39 WO MEN
 40 – 49 MEN
 40 - 49 WO MEN
 50 –59 Men
 50 - 59 Over Women
 60 & Over Men
 60 & Over Women
TOURNAMENT FEES
FORMS
 18-29 TRAD MEN
 18-29 OPEN MEN
 18-29 TRAD WOMEN
 18-29 OPEN WOMEN
 30-39 MEN
 30-39 WO MEN
 40 - 49 MEN
 40 - 49 WOMEN
 50 - 59 Over Men
 50 - 59 Over Women
 60 & Over Men
 60 & Over Women
FIGHTING
 18-29 MEN (159 l bs & UND)
 18-29 MEN (160-179 l bs)
 18-29 MEN (180 l bs & OVER)
 18-29 WOM (129 l bs &U ND)
 18-29 WOM (130 l bs & OVER)
 30-39 MEN
 30-39 WOMEN
 40 - 49 MEN
 40 - 49 WO MEN
 50 - 59 Men
 50 - 59 Over Women
 60 & Over Men
 60 & Over Women
UNDER BLACK BELT DIVISIONS
FIGHTING
 18-29 BEG MEN
 18-29 BEG WOMEN
 18-29 INTER MEN
 18-29 INTER WOMEN
 18-29 ADV MEN
 18-29 ADV WOMEN
 30-39 BEG MEN
 30-39 BEG WOMEN
 30-39 INTER MEN
 30-39 INT ER WOMEN
 30-39 ADV MEN
 30-39 ADV WOMEN
 40-49 BEG MEN
 40-49 BEG WOMEN
 40-49 INTER MEN
 40-49 INTER WOMEN
 40-49 ADV MEN
 40-49 ADV WOMEN
 50 + ALL RANKS MEN
 50 + ALL RANKS WOMEN
PHYSICALLY CHALL.
(ONE DIVISION)
WEAPONS
 5 & UNDER (BOYS/GIRLS) OPEN
 5 & UNDER (BOYS/GIRLS) TRAD
 6 & 7 BEG T RAD (BOYS/GIRLS)
 6 & 7 BEG OPEN (BOYS/GIRLS)
 6 & 7 INT TRAD (BOYS/GIRLS)
 6 & 7 INT OPEN (BOYS/GIRLS)
 6 & 7 ADV TRAD (BOYS/GIRLS)
 6 & 7 ADV OPEN (BOYS/GIRLS)
 8-9 BEG TRAD (BOYS/GIRLS)
 8-9 BEG OPEN (BOYS/GIRLS)
 8-9 INTER TRAD (BOYS/GIRLS)
 8-9 INTER OPEN (BOYS/GIRLS)
 8-9 ADV TRAD (BOYS/GIRLS)
 8-9 ADV OPEN (BOYS/GIRLS)
 10-11 BEG TRAD (BOYS/GIRLS)
 10-11 BEG OPEN (BOYS/GIRLS)
 10-11 INTER TRAD (BOYS/GIRLS)
 10-11 INTER OPEN (BOYS/GIRLS)
 10-11 ADV TRAD (BOYS/GIRLS)
 10-11 ADV OPEN (BOYS/GIRLS)
 12-13 BEG TRAD (BOYS/GIRLS)
 12-13 BEG OPEN (BOYS/GIRLS)
 12-13 INTER TRAD (BOYS/GIRLS)
 12-13 INTER OPEN (BOYS/GIRLS)
 12-13 ADV TRAD (BOYS/GIRLS)
 12-13 ADV OPEN (BOYS/GIRLS)
 14-15 BEG TRAD (BOYS/GIRLS)
 14-15 BEG OPEN (BOYS/GIRLS)
 14-15 INTER TRAD (BOYS/GIRLS)
 14-15 INTER OPEN (BOYS/GIRLS)
 14-15 ADV TRAD (BOYS/GIRLS)
 14-15 ADV OPEN (BOYS/GIRLS)
 16-17 BEG TRAD (BOYS/GIRLS)
 16-17 BEG OPEN (BOYS/GIRLS)
 16-17 INTER TRAD (BOYS/GIRLS)
 16-17 INTER OPEN (BOYS/GIRLS)
 16-17 ADV TRAD (BOYS/GIRLS)
 16-17 ADV OPEN (BOYS/GIRLS)
FORMS
 4 & UNDER (BOYS/GIRLS)
 5 YR OLD (BOYS/GIRLS) OPEN
 5 YR OLD (BOYS/GIRLS) TRAD
 6-7 BEG (BOYS/GIRLS) OPEN
 6-7 BEG. (BOYS/GIRLS) TRAD
 6-7 INT (BOYS/GIRLS) OPEN
 6-7 INT (BOYS/GIRLS) TRAD
 6-7 ADV (BOYS/GIRLS) OPEN
 6-7 ADV (BOYS/GIRLS) TRAD
 8-9 BEG (BOYS/GIRLS) OPEN
 8-9 BEG (BOYS/GIRLS) TRAD
 8-9 INT (BOYS/GIRLS) OPEN
 8-9 INT (BOYS/GIRLS) TRAD
 8-9 ADV (BOYS/GIRLS) OPEN
 8-9 ADV (BOYS/GIRLS) TRAD
 10-11 BEG (BOYS/GIRLS) OPEN
 10-11 BEG (BOYS/GIRLS) TRAD
 10-11 INT (BOYS/GIRLS) OPEN
 10-11 INT (BOYS/GIRLS) TRAD
 10-11 ADV. (BOYS/GIRLS) OPEN
 10-11 ADV (BOYS/GIRLS) TRAD
 12-13 BEG (BOYS/GIRLS) OPEN
 12-13 BEG (BOYS/GIRLS) TRAD
 12-13 INT (BOYS/GIRLS) OPEN
 12-13 INT (BOYS/GIRLS) TRAD
 12-13 ADV (BOYS/GIRLS) OPEN
 12-13 ADV (BOYS/GIRLS) TRAD
 14-15 BEG (BOYS/GIRLS) OPEN
 14-15 BEG (BOYS/GIRLS) TRAD
 14-15 INT (BOYS/GIRLS) OPEN
 14-15 INT (BOYS/GIRLS) TRAD
 14-15 ADV (BOYS/GIRLS) OPEN
 14-15 ADV (BOYS/GIRLS) TRAD
 16-17 BEG (BOYS/GIRLS) OPEN
 16-17 BEG (BOYS/GIRLS) TRAD
 16-17 INT (BOYS/GIRLS) OPEN
 16-17 INT (BOYS/GIRLS) TRAD
 16-17 ADV. (BOYS/GIRLS) OPEN
 16-17 ADV (BOYS/GIRLS) TRAD
FIGHTING
 4 & UNDER (BOYS)
 4 & UNDER (GIRLS)
 5 YR. OLD (BOYS)
 5 YR OLD (GIRLS)
 6-7 BEGINNER (BOYS)
 6-7 BEGINNER (GIRLS)
 6-7 INTERMEDIATE (BOYS)
 6-7 INTERMEDIATE(GIRLS)
 6-7 ADVANCED(BOYS)
 6-7-ADVANCED(GIRLS)
 8-9 BEGINNER (BOYS)
 8-9 BEGINNER (GIRLS)
 8-9 INTERMEDIATE (BOYS)
 8-9 INTERMEDIATE (GIRLS)
 8-9 ADVANCED (BOYS)
 8-9 ADVANCED (GIRLS)
 10-11 BEGINNER (BOYS)
 10-11 BEGINNER (GIRLS)
 10-11 INTERMEDIATE (BOYS)
 10-11 INTERMEDIATE (GIRLS)
 10-11 ADVANCED (BOYS)
 10-11 ADVANCED (GIRLS)
 12-13 BEGINNER (BOYS)
 12-13 BEGINNER (GIRLS)
 12-13 INTERMEDIATE (BOYS)
 12-13 INTERMEDIATE (GIRLS)
 12-13 ADVANCED (BOYS)
 12-13 ADVANCED (GIRLS)
 14-15 BEGINNER (BOYS)
 14-15 BEGINNER (GIRLS)
 14-15 INTERMEDIATE (BOYS)
 14-15 INTERMEDIATE (GIRLS)
 14-15 ADVANCED (BOYS)
 14-15 ADVANCED (GIRLS)
 16-17 BEGINNER (BOYS)
 16-17 BEGINNER (GIRLS)
 16-17 INTERMEDIATE (BOYS)
 16-17 INTERMEDIATE (GIRLS)
 16-17 ADVANCED (BOYS)
 16-17 ADVANCED (GIRLS)
� PRE-REGISTRATION (BEFORE 01/09/15)
ALL SPORT KARATE DIVISIONS ALL EVENTS- $50
3 MAN TEAM FIGHTING - $100
OPEN WEIGHT DIVISONS - $50
SPECTATORS - $10
� REGISTRATION (AFTER 01/09/15)
FIRST SPORT KARATE DIVISION - $55
EACH ADDITIONAL DIVISION - $5
3 MAN TEAM FIGHTING - $125
OPEN WEIGHT DIVISONS - $60
SPECTATORS - $15
� REGISTRATION (DAY OF EVENT)
FIRST SPORT KARATE DIVISION - $60
EACH ADDITIONAL DIVISION - $10
3 MAN TEAM FIGHTING - $150
OPEN WEIGHT DIVISONS - $70
SPECTATORS - $20
ENTRY FEES:
1. (1ST DIV) ________________________________
2. (ADD’L) __________*$__________ =____________
TEAM NAME:
1. _____________________________________________
TEAM TOTAL$__________________
OPEN WEIGHT TOTAL$___________
# OF SPECTATOR TIX __________
SPECTATORS
$10 FOR ADULTS
4 & UNDER FREE
$__________________
TOTAL $__________________
I, THE UNDERSIGNED, HEREBY RELEASE JESSIE WRAY, NEXT LEVEL MARTIAL ARTS, HOOPERSTOWN, MEDICAL STAFF, KRANE AND ALL OTHER PERSONS ASSOCIATED WITH THIS EVENT, IN ANY
CAPACITY, FROM ANY LIABILITY DUE TO INJURY, ETC. THAT I MAY INCUR AS A RESULT OF MY ATTENDANCE AND OR PARTICIPATION AT THE ABOVE EVENT. FURTHERMORE, I HEREBY WAIVE
ANY COMPENSATION WHATSOEVER FOR THE USE OF PICTURES, MOVIES, MEDIA COVERAGE, ETC. UTILIZED BY THOSE ASSOCIATED WITH THIS EVENT AT ANY TIME. I CLEARLY UNDERSTAND
THAT THE FIGHTING ASPECT OF THIS SPORT AND COMPETITION INVOLVES BODILY CONTACT. I HAVE READ, UNDERSTOOD AND AGREE TO ABIDE BY THE RULES ASSOCIATED WITH THIS EVENT
AND ASSUME ALL RESPONSIBILITY AND ANY ASSOCIATED LIABILITY FOR INFRINGEMENT OF SUCH RULES. ADDITIONALLY, I AM FULLY AWARE OF MY PERSONAL MEDICAL CONDITION AND
CERTIFY THAT I AM MENTALLY AND PHYSICALLY FIT TO COMPETE AT SAID KARATE CHAMPIONSHIPS.
SIGNED: _____________________________________________________________________________________________________________ DATE:_____________________________________________________________________________________
(PARENT/GUARDIAN IF UNDER 18)
MAIL CERTIFIED CHECKS/MONEY ORDERS TO: NEXT LEVEL MARTIAL ARTS
501 EAST 163RD STREET, BRONX, NY 10451, PHONE: 718-993-3344