Showdown - Yaw-Yan ArDigma Sacramento

FMASupply.net and Bunal Brand present…
Sacramento Valley
Showdown
Sunday June 5, 2016
Jose P. Rizal Community Center
7320 Florin Mall Drive Sacramento, CA 95823
Application Form
PLEASE PRINT CLEARLY
PERSONAL INFORMATION:
!!!!!!!!!!!
!
!!!!!!!!!!!!!!!!
FIRST NAME
MI
LAST NAME
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
HOME STREET ADDRESS
!!!!!!!!!!!!!!!!!!!!!
!!
CITY
STATE
(!!!) - !!!!!!!
!!/!!/!!!!
HOME NUMBER
DATE OF BIRTH (MM/ DD/ YYYY)
!!!!!
ZIP CODE
!!!!!!!!!!!!!!!!!!!!
E-MAIL ADDRESS
EMERGENCY CONTACT:
!!!!!!!!!!!
!
!!!!!!!!!!!!!!!!
FULL NAME
MI
LAST NAME
!!!!!!!!!!!!!!!!
RELATION
(!!!) - !!!!!!!
CONTACT NUMBER #1
(!!!) - !!!!!!!
CONTACT NUMBER #2
SCHOOL INFORMATION:
!!!!!!!!!!!!!!!!!!!!!!!!!!!
NAME
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
ADDRESS
!!!!!!!!!!!!!!!!!!!!!
!!
CITY
STATE
!!!!!
ZIP CODE
(!!!) - !!!!!!!
TELEPHONE NUMBER
RELEASE FROM LIABILITY WAIVER FORM
READ IT CAREFULLY AND OBTAIN LEGAL ASSISTANCE IF YOU DO NOT UNDERSTAND IT. INITIAL NEXT TO EACH NUMBER
1.
2.
3.
4.
________ - Voluntary Application. I, the undersigned, acknowledge and state that I have ACCEPTED to participate in the Sacramento Valley Showdown
to be held on Sunday June 5, 2016.
________ - Assumption of risk. I am aware and understand that in general, Filipino Martial Arts is a dangerous and hazardous activity, and in particular,
the techniques and methods of this event, all in which as a practitioner in this art, I shall be participating, is an extremely dangerous and hazardous event. I
am voluntarily and of my own free will assuming all risks associated with this event with full knowledge and understanding of the hazards involved.
________ - Health Advisory and Condition. I hereby acknowledge and understand that participating in this event involves extremely strenuous physical
activity and heavy physical contact, and that I have been advised to consult a physician before commencing and undertaking such activity. I hereby represent
that, to the best of my knowledge, I am in good physical health and condition, sufficient to undertake this dangerous and hazardous competition.
________ - Knowing and Voluntary Execution. I hereby declare that I have read this Release from Liability, and that I fully understand the meaning and
importance of its contents. I acknowledge that this Release is a binding contract among Bunal Brand, FMA Supply named above and any and all of these
companies, federations or organizations associates, officials, employees and staff and myself, and that under this contract I am releasing Bunal Brand, FMA
Supply named above and any and all of these companies, federations or organizations associates, officials, employees and staff from all liability for claims I
may have against them. I further declare and represent that I am at least 18 years of age, that I have full legal capacity to be bound by this contract, and that I
am signing this contract of my own free will and accord.
Competitor Signature: ___________________________________________________________________________________________Date: ________
Parent/ Legal Guardian (for competitors 18 years of age and younger)______________________________________________________Date: ________
Sacramento Valley Showdown 2016
Sponsored by FMA Supply and Bunal Brand
Jose P. Rizal Community Center
7320 Florin Mall Drive
Sacramento, CA 95823
AGE
1
!
!
!
!
SEX
SKILL LEVEL
2
Junior (12 & under)
Teen (13-17 years)
Adult (18-39 years)
Senior (40 years and up)
WEIGHT
4
Pre-Tournament
Weight : ___________lbs
Tournament
Weight : ___________lbs
(On-site weigh-in)
3
!
Male
!
Beginner (1 years or less)
!
Female
!
Int/ Advance (1 year and up)
WEIGHT CATEGORY
5
**Promoter reserves
the right to combine
or divide divisions as
needed to meet the
competition
requirement**
EVENTS
6
!
Light Weight 150 lbs and under
!
Middle Weight 151 - 175 lbs
!
Heavy Weight 176 - 200 lbs
!
Super Heavy Weight 201 lbs and up
! Padded Stick (Single)
! Live Stick (Single)
FEES/ PAYMENT
8
Registration Fee:
Additional Event Fee:
$40.00
$40
$15
An additional fee of $15 will be included for anyone that registers
onsite during the day of the event.
Additional Events
$_____.00
Day of event registration
$_____.00
Total
$_____.00
Make checks payable to: FMA Supply
Please refer all questions to fmasupply@gmail.com
**If you are interested in registering online, please email a signed and completed
copy to fmasupply.net and make your payment at fmasupply.net website (Addt'l
fees may apply)**
Mail to: FMA Supply
C/O Sacramento Valley
Showdown 2015
10473 Folsom Blvd
Rancho Cordova, CA 95670