East Coast Sparring Championships
East Coast Sparring Championships
Saturday December 5th 2009
This is a Double Elimination event.
Cash Only At Door
No refunds.
Please make check (preregistration only) payable to: Mt. View Open
Mail to : Mt. View Karate #379
905 Hwy 321 NW
Hickory NC 28601
Name:_____________________________________________
Address:___________________________________________
City:_____________________ State:______ Zip:________
Phone:_________________ e-mail:_______________________________
Age*_____ M:_______ F:________ Date of Birth:____/_____/______ * Participants must compete in
age & rank division based on their age & rank as of the day of tournament – not on Jan 1st*
Belt color*:________ Weight:_____ School Name:___________ Instructor:_________
Preregistration fee (postmarked by Nov. 23rd) $45.00 At the door $50.00
Spectators are $6.00 each with preregistration or $8.00 at the door (kids 6 & under free)
Coach passes are $20.00 (spectator pass not needed for coaches)
Division Fee :_____ + Coach Pass:_______+ Spectators __________ = _______
Total enclosed:_________
I, the undersigned, do hereby voluntarily submit my application for attendance/participation in the East Coast Sparring Championships and do
hereby assume full responsibility for any and all damages, injuries, and losses that I may sustain or incur in any way while
attending/participating, and I hereby waive all claims against the promoters, operators, sponsors, Hickory Metro Convention Center, or anyone
directly or indirectly associated with this tournament for any injury or claim that I may sustain. I consent that any photographic or video images
taken of me in conjunction with the East Coast Sparring Championships can be used for publicity, promotion, or television showing, and I waive
all claims for compensation in regard thereto.
Signature of participant( or parent/legal guardian if under 18 years of age) Date
Saturday December 5th 2009
This is a Double Elimination event.
Cash Only At Door
No refunds.
Please make check (preregistration only) payable to: Mt. View Open
Mail to : Mt. View Karate #379
905 Hwy 321 NW
Hickory NC 28601
Name:_____________________________________________
Address:___________________________________________
City:_____________________ State:______ Zip:________
Phone:_________________ e-mail:_______________________________
Age*_____ M:_______ F:________ Date of Birth:____/_____/______ * Participants must compete in
age & rank division based on their age & rank as of the day of tournament – not on Jan 1st*
Belt color*:________ Weight:_____ School Name:___________ Instructor:_________
Preregistration fee (postmarked by Nov. 23rd) $45.00 At the door $50.00
Spectators are $6.00 each with preregistration or $8.00 at the door (kids 6 & under free)
Coach passes are $20.00 (spectator pass not needed for coaches)
Division Fee :_____ + Coach Pass:_______+ Spectators __________ = _______
Total enclosed:_________
I, the undersigned, do hereby voluntarily submit my application for attendance/participation in the East Coast Sparring Championships and do
hereby assume full responsibility for any and all damages, injuries, and losses that I may sustain or incur in any way while
attending/participating, and I hereby waive all claims against the promoters, operators, sponsors, Hickory Metro Convention Center, or anyone
directly or indirectly associated with this tournament for any injury or claim that I may sustain. I consent that any photographic or video images
taken of me in conjunction with the East Coast Sparring Championships can be used for publicity, promotion, or television showing, and I waive
all claims for compensation in regard thereto.
Signature of participant( or parent/legal guardian if under 18 years of age) Date
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