Competitor Registration Form

ONLY for OUT OF REGION STUDENTS. ALL students in Region 115, you are REQUIRED to register with your Instructor.

*Please fill out this form with the Student's Information - ALL Fields are REQUIRED*
 
Competitor Name:                              ATA Number:                    Age:            Birth Date (MMDDYY):          Gender:                           
                           Select Gender Female Male  

Current Rank:                                    Rank Wish to Compete As:
       

School Number:                                School City / State:                             Region Number:
               

Instructor Name:                                Your Email Address:
       
Comments:


Please check the areas you wish to compete.

Traditional Forms/Sparring
Protech Weapons
Extreme Forms
Extreme Weapons
Creative Forms
Creative Weapons

Please check if you plan on attending the Friday Seminar.
Bill "Superfoot" Wallace Seminar



**Note: If you do not compete you will receive a 50% refund. Please notify us immediately by email.**