The 29th Annual KTA Open Tae Kwon Do Championships
Online Registration Form
Contestant Information
Name:
First Name Last Name
Date of Birth
:
/
/
M/F:
M
F
Address:
Street
City
State
Zip
Belt:
White
Yellow
Orange
Purple
Green
Blue
Brown
Red
Black Belt
Select
1st Degree
2nd Degree
3rd Degree
4th Degree
5th Degree
6th Degree
7th Degree
8th Degree
9th Degree
Phone:
Height:
Weight:
lbs.
Email:
School / Studio Information
School/Studio:
Email:
Instructor:
Master:
Address:
Street
City
State
Zip
Phone:
Fax:
Competition Information
Check the box next to the event(s) for which you want to register
Poomse / Traditional forms
Gyrooki / Sparring (Protective Equipment Mandatory)
Creative forms / Open forms
Entry Fee:
1 Event -
$60.00
2 Events -
$70.00
3 Events -
$80.00
I have read and accepted the
Liability Waiver Form, Release, And Indemnification Agreement.
All fields are mandatory
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