2008 Registration
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Please print and mail this form with payment to: Mt. View Open #379
905 HWY 321 NW
HICKORY NC 28601
CASH ONLY AT DOOR
Players Name____________________________________________ M/F:________
Address_______________________________________________________________
City_____________________________ State ___________ Zip ___________________
Home Phone __________________ e-mail_____________________________________
Birth Date____/_____/____ Age as of January 1st 2008 ______________
Belt Rank_____________________ Weight (Sparring only)_____________
School _________________________________Instructor_____________________________
Team__________________________________________________
If you include an e-mail address, we will send you confirmation of your pre-registration.
Please list all divisions legibly.
Event Type Before July 8 At Door Division No.
1st Event $45.00 $50.00 _______
2nd Event $15.00 $20.00 _______
3rd Event $15.00 $20.00 _______
4th Event $10.00 $15.00 _______
5th Event $10.00 $15.00 _______
6th Event $10.00 $15.00 _______
7th Event $10.00 $15.00 _______
8th Event $10.00 $15.00 _______
Little Dragons $25.00 $35.00 _______
Team Fighting $75.00 $90.00 _______
Team Forms $75.00 $90.00 _______
Coach Pass $15.00 $20.00 _______
Spectator (Fri) $ 3.00 $ 5.00 _______
Spectator (sat) $ 7.00 $10.00 _______
(kids 5 & under Free)
Total Enclosed: __________ __________
I, (print name)_____________________________________________ hereby waive any and all
rights or claims I may have against the NBL, the Mountain View Open Karate Championships, SKIL,
SKITA, Mountain View Karate Centers, Doug Armstrong, the Hickory Metro Center, and/or any staff,
agents, employees, opponents or officials, and I hereby release and discharge them from any and
all claims resulting from injuries including death, damages, or loss, which may occur to me or my
heirs arising out of or in any way connected with my attendance and/or participation in any NBL or
SKIL sanctioned event(s). I represent and warrant that I am physically and mentally fit, able to
participate, and I do hereby assume responsibility for my own well being, understanding that
participation involves bodily contact, I have read understand and agreed, to abide by the SKITA
rules, associated with the NBL/SKIL events ands assume all responsibility and any liability for
infringement of such rules and agree to accept the tournament arbitrators as final. I consent to
allow any reproductions and likeness created in any manor whatsoever, photographed, filmed or
video taped in connection with NBL/SKIL events which can be used for instruction, publicity,
promotion, or television broadcast and I waive any and all compensation in regard thereto.
_____________________________________________________________________________
Competitor or parent/guardian Signature who assumes complete responsibility (if under 18)
905 HWY 321 NW
HICKORY NC 28601
CASH ONLY AT DOOR
Players Name____________________________________________ M/F:________
Address_______________________________________________________________
City_____________________________ State ___________ Zip ___________________
Home Phone __________________ e-mail_____________________________________
Birth Date____/_____/____ Age as of January 1st 2008 ______________
Belt Rank_____________________ Weight (Sparring only)_____________
School _________________________________Instructor_____________________________
Team__________________________________________________
If you include an e-mail address, we will send you confirmation of your pre-registration.
Please list all divisions legibly.
Event Type Before July 8 At Door Division No.
1st Event $45.00 $50.00 _______
2nd Event $15.00 $20.00 _______
3rd Event $15.00 $20.00 _______
4th Event $10.00 $15.00 _______
5th Event $10.00 $15.00 _______
6th Event $10.00 $15.00 _______
7th Event $10.00 $15.00 _______
8th Event $10.00 $15.00 _______
Little Dragons $25.00 $35.00 _______
Team Fighting $75.00 $90.00 _______
Team Forms $75.00 $90.00 _______
Coach Pass $15.00 $20.00 _______
Spectator (Fri) $ 3.00 $ 5.00 _______
Spectator (sat) $ 7.00 $10.00 _______
(kids 5 & under Free)
Total Enclosed: __________ __________
I, (print name)_____________________________________________ hereby waive any and all
rights or claims I may have against the NBL, the Mountain View Open Karate Championships, SKIL,
SKITA, Mountain View Karate Centers, Doug Armstrong, the Hickory Metro Center, and/or any staff,
agents, employees, opponents or officials, and I hereby release and discharge them from any and
all claims resulting from injuries including death, damages, or loss, which may occur to me or my
heirs arising out of or in any way connected with my attendance and/or participation in any NBL or
SKIL sanctioned event(s). I represent and warrant that I am physically and mentally fit, able to
participate, and I do hereby assume responsibility for my own well being, understanding that
participation involves bodily contact, I have read understand and agreed, to abide by the SKITA
rules, associated with the NBL/SKIL events ands assume all responsibility and any liability for
infringement of such rules and agree to accept the tournament arbitrators as final. I consent to
allow any reproductions and likeness created in any manor whatsoever, photographed, filmed or
video taped in connection with NBL/SKIL events which can be used for instruction, publicity,
promotion, or television broadcast and I waive any and all compensation in regard thereto.
_____________________________________________________________________________
Competitor or parent/guardian Signature who assumes complete responsibility (if under 18)
| Contact Information 905 HWY 321 NW Hickory NC 28601 828-446-1477 You can e-mail us at: Mt View Open All pictures provided courtesy of RJ Bishop |
