REGISTRATION
FORM
1ST ANNUAL
WYOMING VALLEY’S MID-ATLANTIC CLASSICS Please Print/Check the number of events
entered |
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Name (First, MI, Last)
___________________________________________________________________________________________
Rank______________ |
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Address:
_______________________________________________________________________________________________________
Age: ______________ |
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City:
_______________________________________________________________________
State: ________ Zip:___________ Phone: __________________ |
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School Name:
___________________________________________________________________________________
Instructor: ________________________ |
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Address:
_______________________________________________________________ City:
_____________________ State: _________ Zip: _____________ |
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E-Mail Address:
_________________________________________________ No. of Events: _________
Total Amt $ _________________________________ |
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SELF DEFENSE (must pre-register) |
TEAM FORMS - MAY USE WEAPONS (must
pre-register) | ||
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Rank |
Youth 17 & Under |
Adult 18 & Over |
ALL RANKS/ALL AGES/MAY INCLUDE
MUSIC |
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Black |
____ |
____ |
Separate Registration Form & Fees Next
Page |
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Int/Adv |
____ |
____ |
(Does not have to be synchronized, but can
be) |
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Beginner |
____ |
____ |
Minimum 2 competitors |
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2 minute time limit |
4 minute time limit | ||
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WEAPONS |
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BLACK BELT: |
UNDERBELTS: |
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___ 30 and up |
Men |
___ 18 and up |
Advanced |
___ 10 to 13 |
Intermediate |
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___ 18 to 29 |
Men |
___ 18 and up |
Int/Beg |
___ 10 to 13 |
Beginner |
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___ 18 and up |
Women |
___ 14 to 17 |
Advanced |
___ 9 & under |
Advanced |
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___ 16 & 17 |
Boy/Girl |
___ 14 to 17 |
Intermediate |
___ 9 & under |
Intermediate |
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OPEN FORMS (all forms included) |
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Black Belts: |
Underbelts: |
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__ 35 & up |
Men/Women |
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__ 35 & up |
Int/Adv |
Men/Women |
__ 12-13 |
Adv |
Boy/Girl | ||||||
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__ 35 & up |
Beg |
Men/Women |
__ 12-13 |
Int |
Boy/Girl | ||||||||
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__ 18 to 34 |
Men |
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__ 18 to 34 |
Adv |
Men/Women |
__ 12-13 |
Beg |
Boy/Girl | ||||||
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__ 18 to 34 |
Int |
Men/Women |
__ 10-11 |
Adv |
Boy/Girl | ||||||||
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__ 18 to 34 |
Women |
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__ 18 to 34 |
Beg |
Men/Women |
__ 10-11 |
Int |
Boy/Girl | ||||||
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__ 16 to 17 |
Adv |
Boy/Girl |
__ 10-11 |
Beg |
Boy/Girl | ||||||||
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__ 16 to 17 |
Boy/Girl |
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__ 16 to 17 |
Int |
Boy/Girl |
__ 8-9 |
Int/Adv |
Boy/Girl | ||||||
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__ 16 to 17 |
Beg |
Boy/Girl |
__ 8-9 |
Beg |
Boy/Girl | ||||||||
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__ 14 to 15 |
Boy/Girl |
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__ 14 to 15 |
Adv |
Boy/Girl |
__ 6-7 |
Int/Adv |
Boy/Girl | ||||||
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__ 14 to 15 |
Int |
Boy/Girl |
__ 6-7 |
Beg |
Boy/Girl | ||||||||
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__ 13 & under |
Boy/Girl |
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__ 14 to 15 |
Beg |
Boy/Girl |
__ 5 & under |
All Belts |
Boy/Girl | ||||||
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