1999 Region 6 - Atlantic-Pacific Tang Soo Do Federation printable pdf download

2016 APTSDF

SOUTHEASTERN REGIONAL CHAMPIONSHIP

Saturday, April 16th, 2016

Date / Time:

Saturday, April 16

, 2016

Opening Ceremonies after Black Belt Competition

Black Belt Competition – 9:00 am

Color Belt Competition immediately after opening ceremonies

Where:

Trussville Civic Center (TCC)

5381 Trussville-Clay Road

Trussville AL 35173

$40.00 per competitor (includes all 4 events – forms, weapons, sparring, and

Participant Fees:

Breaking)***ADD $15.00 for a Championship T-Shirt

Adults $5.00 – Children $3.00

Spectator Fees:

Awards

Place, 2

Place, 3

Place, and Co-3

Place

Sparring – Hand and Foot Protection (must cover tips of fingers and toes), Head

Equipment:

protection, mouthpiece, groin cup (men)

Competition Divisions:

Individual Forms, Sparring, Weapons, and Breaking

Registration:

All events are PRE REGISTER ONLY, must be received no later than 4/2/16

Sr. Master Heather Potter or Master Will Potter

Information:

Birmingham Academy of Martial Arts

Or HQ at (770) 614-0006

To Register Complete Entry Form Below, cut on dotted line and return with your fee made payable to:

ATLANTIC-PACIFIC TANG SOO DO FEDERATION OR APTSDF

Mail To:

Atlantic-Pacific Tang Soo Do Federation

World Headquarters

PO Box 3225

Suwanee, GA 30024-0990

Official Registration

NAME:____________________________________________________AGE:_______WEIGHT_______ M/F

ADDRESS:________________________________________CITY______________STATE_______ZIP______

BELT RANK_______________________ INSTRUCTOR___________________________________________

SCHOOL NAME:_______________________SCHOOL ADDRESS:__________________________________

Check divisions competing: _____individual forms _____sparring _____weapons _______breaking**

** (must purchase boards below)

Payment Amount: Competition Fee $40 (Must be received by 04/2/15) after 04/2/15 fee is $50.00.

No registrations after 4/9/15. ***Note: There is NO discount for participating in less than 4 events.

Fee does not include boards!***

+ T-Shirt at $15 per shirt - T-shirt order/Circle One: (Child S, M, L) (Adult S, M, L, XL, XXL)

**++ Boards $3 Per Board write # of boards to left of size –______pee wee______6”, _____8”, _____10”

Total Amount Enclosed $___________

LIABILITY WAIVER

I hereby submit my application for registration in the 2016 APTSDF Southeastern Regional Championship. I agree to waive all claims against any and all persons, The

Atlantic-Pacific Tang Soo Do Federation, Karate World, Birmingham Academy of Martial Arts, and TCC or its officers and agents, for any injuries I may sustain

related to said championship. I also assume full responsibility for all my actions in connection with said championship. I understand that the Atlantic-Pacific Tang Soo

Do Federation, for publicity and without compensation may use any pictures of me participating in said championship. THERE ARE NO REFUNDS. ALL

TRANSACTIONS ARE FINAL.

Entrant Signature _________________________________________Date______________

Guardian Signature _________________________________________Date______________

(Must be signed by guardian if entrant is under 18)