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Pre-Register by Mail

To Pre-Register by mail is simple. Complete the form below and mail it to USEWF headquarters at the following address:

John V. Patterson

USEWF Tournament

120 Del Crest Drive

Nashville, TN 37217

 

Please Note that this form is to be used for Pre-Registration only and will not be accepted on the day of the Tournament and must be received on or before March 6, 2018.

 

Your pre-registration package will be mailed to you so please include your mailing address below.

 

C. T. Patterson Memorial USEWF

Championships

PRE-REGISTRATION FORM

 

Complete each blank and sign disclaimer.

Please print legibly

 

Name___________________________________________________________Age______

 

Belt Color ____________________________ Gender: ___________ 

 

Home Phone:_______________________________

 

Home Address:____________________________________________________________

 

City:____________________________ State:________________ZIP:_______________

 

Karate School________________________________Instructor_______________________

 

 

WAIVER AND RELEASE OF LIABILITY

 

In consideration of the promoterís permission and acceptance, granted to the competitors to participate in this event, I hereby assume all risks arising from said tournament/seminar and hereby release the directors of the tournament, U. S. Eastern Wado-Ryu Karate-Do Federation., Columbia State Community College, State and County School System, City of Columbia, their agents, employees and volunteer workers any demands, that I, my heirs, executors, administrators or assignees may have against all such parties, for all personal injuries known or unknown which the competitor may incur in this event.

I understand that karate competition/training involves significant and substantial physical contact between participants and that the competitor may receive injuries as a result.  I have read and understand this release and understand and agree to all its items.

I agree to the rules of the event and will make myself knowledgeable of U.S.E.W.F. rules for karate competition and agree to abide by said rules.

 

 

 

__________________________________________      ______________________________________

Signature of Competitor                                          Date       Parent or Guardian if under 18 years old    Date

 

 

 

Spectator Tickets  (Amount Needed)  _______ @ $6.00 = ________ Children Under 5 are free

 

 

$35.00 for one or two events

 

Please check below the event(s) you will be entering

 

Male (   )  Female (   )

 

Fighting(     )   Forms(     ) 

 

Must be 18 or Older

Black Belt Open Special Kata Competition $35.00 (  )

 

  Black Belt Open Kumite Special Competition $35.00 (  )

 

Black Belt Kihon Kata Open Team of Two  $50.00 per Team(   )

 

Black belts can compete in regular events as well as above special events

 

Total Amount: Spectator Tickets ________ + Event Amount ______

 

Total Enclosed = _____________

 

Make Check payable to USEWF and send:

John V. Patterson, Tournament Director

120 Del Crest Drive

Nashville, TN 37217

 

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