Regional championship



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2016 APTSDF New England

REGIONAL CHAMPIONSHIP



October 22, 2016

Date / Time:

Saturday October 22nd , 2016

Black Belt Judges Meeting & Score Keepers Meeting at 9:00 am

Black Belt Competition – 10:00 am

Opening Ceremonies & Color Belt Competition immediately afterwards

Where:



Bethany Covenant Church, 785 Mill St

Berlin, CT  06037

(860) 828-3637


Participant Fees:

$40.00 per competitor – Early Bird Registration*** (includes all 4 events – forms, weapons, sparring, and breaking)*** Must be received no later than 10/1/16 - $45.00 per competitor. Regular Registration** Must be received no later than 10/8/16. $50.00 for late registration. Must be received by no later than 10/15/16

Spectator Fees:

$5.00 for 13 years of age and over & $3.00 for children over 6

Awards

1st Place, 2nd Place, 3rd Place, and Co-3rd Place

Equipment:

Sparring – Hand and Foot Protection (must cover tips of fingers and toes), Head protection, mouthpiece, groin cup (men & boys)

Competition Divisions:

Forms, Sparring, Weapons, and Breaking

Registration:

All events are PRE REGISTER ONLY, must be received no later than 10/1/16

Information:

Contact APTSDF HQ at (770) 614-0006 or New England RD


To Register Complete Entry Form Below, cut on dotted line and return with your fee made payable to:

ATLANTIC-PACIFIC TANG SOO DO FEDERATION OR APTSDF


Mail To:

Atlantic-Pacific Tang Soo Do Federation

PO Box 3225

Suwanee, GA 30024




2016 New England Regional Championship
October 22nd, 2016

Official Registration

NAME:____________________________________________________AGE:_______WEIGHT_______ M/F



ADDRESS:________________________________________CITY______________STATE_______ZIP______
BELT RANK_______________________ INSTRUCTOR___________________________________________
SCHOOL NAME:_______________________SCHOOL ADDRESS:__________________________________

Check divisions competing: _____forms _____sparring _____weapons _______breaking

Payment Amount: $40.00 per competitor – Early Bird Registration*** (includes all 4 events – forms, weapons, sparring, and breaking)*** Must be received no later than 10/1/16 - $45.00 per competitor. Regular Registration** Must be received no later than 10/8/16. $50.00 for late registration. Must be received by no later than 10/15/16. Special Note: Competitors may bring their own boards as long as they meet Federation standards. See your instructor for specific information related to proper sizing, quality, make, etc.

Total Amount Enclosed $___________

LIABILITY WAIVER

I heareby submit my application for registration in the 2016 APTSDF New England Regional Championship. I agree to waive all claims against any and all persons, The Atlantic-Pacific Tang Soo Do Federation, Sunny Side Martial Arts, Bethany Covenant Church, its officers and agents, for any injuries I may sustain related to said championship. I also assume full responsibility for all my actions in connection with said championship. I understand that the Atlantic-Pacific Tang Soo Do Federation, for publicity and without compensation or authorization may use any pictures of me participating in said championship. I also understand there are no refunds after the registration deadline date.

Entrant Signature _________________________________________Date______________



Guardian Signature _________________________________________Date______________ (Must be signed by guardian if entrant is under 18)


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