Grappling Tournaments : Event Registration

Registration

BEST of the WEST Submission Grappling Championship Registration Form

Submission Grappling Saturday, July 23rd, 2011

Location
Long Beach Convention Center, Long Beach, CA. USA.

Pre-Registration ends Wednesday, July 20th, 2011. Domestic mailed registration must be postmarked by Monday, July 18th, 2011.

4 Registration options:
1: Proceed with online registration and pay by Credit Card or Pay Pal Now

2: Proceed with online registration and pay at door (Extra $15 at door processing fee).

3: Complete Registration Form and Mail with check or money order to:
World Grappling Games
5402 Commercial Lane
Huntington Beach, CA 92649

4: Register at weigh-ins or at door and pay $20 late registration fee

Contestant Contact Info

First Name:
Last Name:
Email Address:
Address:
City:
State:
Zip/Postal Code:
Country:
Phone Number:
Cell Phone Number:

Payment Information

Payment Method:	Credit Card Now At Door
Name on Credit Card (If paying by Card):

Emergency Contact Name

Emergency Contact Name:
Emergency Phone Number:

Tournament Division Options

Gender:
Age:	Weight:	lbs.
Judo Belt:
Wrestling:
BJJ Belt:
Grappling Level:
Pankration Level:

Academy Information

Academy Name:
Academy Phone Number:
Instructor Name:

Division Sign up

Event Selection:
Division:

Disclaimer and Signatures

By checking this check box, I understand the rules of the tournament and will abide by them. I understand that I am participating in a sport that usually has body contact. I assume full responsibility for all of my actions during and connected to the above tournament. I understand that martial arts are a potentially dangerous and/or fatal sport and agree that I will not hold G.T.A. or any of its employees and associates, tournament sponsors or hosting venue for any type of injury, loss, or death sustained while competing in this competition. I also state that I am in good physical condition and know of no reason why I cannot participate in this Martial Arts event. I have current and valid health insurance. I understand that divisions or weight classes are subject to change. I understand that G.T.A. does not offer refunds. In case of an emergency, I hereby authorize any licensed medical personnel to perform any accepted medical procedure deemed necessary and I agree to bear the expense of any such treatment. I also agree that my attendance and/or performance at the tournament may be photographed, filmed, or taped and used by G.T.A. and I waive any compensation thereof. I have read the rules and the release above and agree to all of its terms and enter this application to complete this form.

I Agree
Signature (REQUIRED FIELD Enter your name or if you are under 18 Parent or Guardian must enter theirs.):		Date: