October 7, 2017, AIKC Rochester NY Online Registration
Please fill in this form as completely and as accurately as possible. Please mail in PAYMENT AND WAIVER FORM to complete registration.
First Name *
Your answer
Last Name *
Your answer
Middle Initial
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Enter age on October 7, 2017
Your answer
Gender *
Height *
Your answer
Weight *
Your answer
Street address
Your answer
City *
Your answer
State/Province
Your answer
email address
Your answer
Dojo/School *
Your answer
Martial Arts Style
example: Kyokushin Karate
Your answer
Instructor *
Your answer
Instructor/Dojo Phone Number:
Your answer
Rank(kyu)
Either enter kyu or belt color.
Your answer
Rank(Dan)
Your answer
Years of Experience *
Events
Tournament Director reserves the right to combine or further divide divisions based on registration.
Clicker *
May only register for one(1) fighting event. (Clicker or Semi-Contact)
Required
Semi-Contact *
May only register for one(1) fighting event. (Clicker or Semi-Contact)
Required
Kata *
Required
Weapons Kata *
Required
Creative Breaking *
Required
Knock Down *
(Please Complete Separate Application and Waiver)
Required
Payment and Waiver
One event is $45 and $10 for each additional event
**add $10.00 after September 30th, 2017***
All entry fees are non refundable.

Please Print and Mail the Waiver and Payment form. Groups of forms may be collected by Instructor and submitted as a single package. (http://www.graywolfmartialarts.com/files/2017_Waiver_and_Payment_Form.pdf)

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