Name______________________________Rank____________
Birthdate___________________________Age_____________
Address____________________________________________
E-mail address_______________________________________
City_________________________State_______Zip Code_________
Name of School___________________________ Style______________
Instructor_________________________School Location______________

Competitor Release - Liability Waiver

I, the undersigned, do hereby voluntarily submit my application for participating in the Traditional Taekwon-do Forms Tournament to be held beginning at 9  a.m October 22, 2011 at Sunnyside United Methodist Church, 3520 S.E. Yamhill St., Portland, OR 97214   I assume full responsibility for any and all damages, injuries or losses which I may sustain or incur while attending or participating.  I hereby waive all claims against the promoters, the sponsors, the church, the building owners, or individuals for injuries I may sustain.  I fully understand that my entry fee is NON-REFUNDABLE.  I HAVE READ AND FULLY UNDERSTAND THE ABOVE WAIVER.

________________________________________ ____________
Signature of Competitor     Date

_________________________________________ ______________
Signature of Guardian if Competitor is under 18  Date

ENTRY FEE:
$30 for on student
$20 for each additional student in family
$10 extra if registering after October 17, 2011.

UNLIMITED ENTRY TO ALL EVENTS ALLOWED BY RANK

Make check or money order out to  Hwa-Rang Foundation and mail to:
Traditional Taekwon-do
2940A SE Belmont St.
Portland, OR 97214
You may also be able to give entry forms to your instructor to be turned in.
 

For more information, call Gil Johnson at (503) 736-9634
Or e-mail to tkdpdx@spiritone.com