Name of Payor *

Please enter the name under which payment was made. REMEMBER: Your registration is not complete until all applicable entry fees have been received.

First Name

Last Name

NAME OF COMPETITOR: *

Enter Competitor's Name.

First Name

Last Name

Birth Date *

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DD

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Phone *

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REGISTERED EVENTS: Check all events that apply *

Kata/Forms (Empty Hand)

Open Event

Kumite/Sparring

Team Synch Kata

Chanbara