ACT Championships

Name*

First Last

Gender*

Male
Female

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Enter Email Confirm Email

Date of Birth*

Are you currently a United ITF Taekwondo Australia Inc (INO23) member ?*

Yes
No

If unsure, please check secretary@uniteditf.com

Age on Day of Competition (26/5/19)*

Under 18
18+

Total

$ 0.00

Rank (Must indicate - Gup or Degree)*

Club Name*

Instructor's Name*

Weight (kgs) - only required if sparring

height (cm) - only required if sparring

Select Events (please tick)*

Sparring (individual)
Patterns (individual)
Patterns (team)
Power Breaking (13yrs+ only)
Special Techniques (13yrs+ only)
Junior Breaking Combo Event (8-12yrs only)

Note: if selecting team events, you must ensure 4 other members have registered and paid for the same team event. Team age category will be according to the oldest team member.

Participant waiver*

I, the undersigned, in consideration of, and as a condition of acceptance of my entry in the tournament hosted by “United ITF Taekwon-Do (Australia) Inc., Choong Moo Taekwon-do, for myself, my heirs, executors and administrators hereby waive all and any claims, right or cause of action which I or they may otherwise have, for or arising out of loss of life or injury , damage or loss of any description whatsoever, which I might suffer or sustain in the course of, or consequent upon my entry and participation in the said tournament. I understand and accept, that with all participation in sporting events combative in nature, that there is an acceptable element of risk.

Where participant is under 18 years of age, parent or legal guardian must check this box on their behalf.

If you have any medical condition that may impact your ability to take part in this event, please provide details here:

Name

This field is for validation purposes and should be left unchanged.

ACT Championships

Sunday 26th May, 2019