When: Saturday, August
21, 2010
Where: North Rowan High
School
300 N. Whitehead
Ave. Spencer, NC 28159
Elimination: Registration
8:00 a.m. until your division starts.
9:00 a.m. SHARP with
Breaking & Self Defense, Lil- Dragons followed by all 17 & under
Belts & Black Belt Musicals, Trad. Weapons, Trad. Forms, Open Weapons,
Open Forms & Sparring. Handicapable Division. 18+ Divisions will start
in the same order as the Jr. Divisions above. Adult Black Belts will compete
last.
Pre-Registration: $35.00 for 1 event & $5.00 for each additional event. No checks will be accepted, only certified checks and money orders made out to Larry Dillingham and mail to: PO Box 3238, Salisbury NC 28145. This must be received by Aug. 13, 2010 for pre-registration.
Registration at the door: $40.00 for 1 event & $10.00 for each additional event. (NO REFUNDS) CASH, Certified Checks or Money Orders will be accepted at the door.
Spectator Fee: $5.00 – 4 and under FREE
Coach’s Pass: $15 – Must have in order to coach. Only 1 coach per fighting match. (Addition to Spectator Fee)
Arbitrator: Garry Dillingham Coordinator: Donald McCluney
Recognition: Sanctioned by The Dojo. Dojo rules will apply. Please train accordingly. They will be enforced. May God Bless each of you to have a safe trip here and a safe return home.
ATTENTION!!! PLEASE READ!!!
The 15th Annual Foothills
Karate Classic is offering 200 divisions to choose from. All competitors
must use the division numbers when registering. Ring assignments will be
made according to your division number. If ring changes become necessary
to run divisions faster, please listen closely to all announcements. NO
REFUNDS will be given for missed divisions!
Pre-Registration Form: $35 for 1 event & $5.00 for each additional event. Please return by Aug. 13, 2010. Certified Checks and Money Orders only will be accepted. Please make them out to Larry Dillingham and mail to PO Box 3238 – Salisbury NC 28145. No Personal, Studio or Sponsor Checks will be accepted. Bring birth certificate for age verification.
Name: ______________________________________________________________ DOB _____________________ Age __________________
Address: _______________________________________________________________________________________ M_____ F_____
City: _______________________________________________________ State ____________ Zip _____________________
Phone: ______________________________________________________ Belt Rank _____________________________________
Nov. _____________ Int. ____________ Adv. ________________ BB _____________
Instructor: _____________________________________________________________
Studio Address: ________________________________________________________
City: _____________________________________________ State _____________ Zip _________________________________
Studio Phone: ____________________________________________________
Please list division #
for all divisions you are competing in: See Division list below.
Breaking, Self-Defense,
Musical, BB Musical Weapons 17-, Trad. Weapons, Trad. Forms, Open Weapons,
Open Forms, Handicapable Form/Weapons, Sparring.
1. __________ 2. __________ 3. ___________ 4. __________ 5. ___________ 6. __________ 7. __________ 8. __________ 9. __________ 10. ________
1 event $35 ______________ Plus _______________ x $5.00 per additional events = $____________________
Coaches Pass (Additional to Spectator Fee) $15.00 _______________________
Spectator Fee _______________ x $5.00 = $_____________ Total $________________________
After Aug. 13, 2010: 1 event $40.00 ______________ Plus _________ x $10.00 per additional events = Total $__________________
Release/Waiver
I, the undersign, do
hereby voluntarily submit my application for attendance/participation in
the 15th Annual Foothills Karate Classic and do hereby assume full responsibility
for all damages, injuries and losses that I may sustain or incur in any
way while attending and participating in this event. I also waive all claims
against the Promoter, the North Rowan High School or anyone directly or
indirectly assoc`iated with this tournament for any claim or injury that
I may sustain.
Signature of Competitor
(Parent if competitor is under 18) _________________________________________________________________________