Grappling Tournaments : Event Registration

Registration

The OTM 2010 Northeast Regional Championship at the Philly Sports Extravaganza Registration Form
Brazilian Jiu-Jitsu - Saturday January 9th, 2010 held at Valley Forge Convention Center-King of Prussia. This event is part of the Tokey Hill Challenge Combat Arena.
Pre-Registration ends Wednesday, January 6th 2010. Domestic mailed registration must be postmarked by Monday, January 4th, 2010.

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

2: Proceed with online registration and pay at door. $15 fee

3: Complete Registration Form and Mail with check or money order to:
World Grappling Games
15833 Chemical 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:	Credit Card Now At Door
Name on Card (If paying by Card):

Emergency Contact

Emergency Contact:
Phone Number:

Personal Info

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

School Info

School:
Phone Number:
Instructor:

Division

Event:
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
Name (Enter your name or Parent or Guardian must enter theirs if your under 18):		Date: