2009 Winter Olympics Pre-Registration

Your Info

First Name

Last Name

Age

Day Time Phone

()

Date of Birth

Address

City

Weight

lbs.

State

Zip Code

Sex

School Instructor

Your Rank

Degree, Dan, Kyu

Prices listed if Postmarked Before June 04, 2009 If not Postmarked by June 04, 2010 then at the door fees will apply: First Event - $65.00 Additional Event - $25.00


*Continuous Sparring	x $45.00	=
*TKD Sparring	x $45.00	=
Point Sparring	x $45.00	=
Controlled Sport Mixed Martial Arts (CSMMA Sparring)	x $45.00	=
*West Coast Sparring	x $45.00	=
*Simulated Blade Fighting	x $45.00	=
*Grappling	x $45.00	=
*Padded Stick Fighting	x $45.00	=
First Event (if not sparring)	x $45.00	=
Each Additional Event	x $20.00	=
Demo Team (Per person)	x $25.00	=
Musical Forms	x $45.00	=
Weapons Forms	x $45.00	=
TKD Forms	x $45.00	=
Team Sparring (Per Person)	x $25.00	=
Synchronized Team Sparring (Per Person)	x $25.00	=
Coach Pass (all 3 days)	x $25.00	=
Friday Tickets	x $15.00	=
Saturday Tickets	x $15.00	=
Sunday Tickets	x $15.00	=
Video Pass ( All 3 Days)	x $25.00	=
VIP Ringside seating ( All 3 days)	x $50.00	=
Coaches Pass	x $20.00
2009 World Championships Patch	x $5.00	=
Large Gear Bag	x $25.00	=
IMAC Memebership	x $25.00
IMAC Rule Book	x $5.00	=
Total =
Additional Comments or Special Needs?








	TOTAL Enclosed	=

Division Numbers

Self Defense/Handi-Capable

Co-Ed & Team Sparring #

Team Continuous Sparring

Point Sparring #

*Continuous Sparring #

Mixed Martial Arts

West Coast Sparring

*TKD Sparring #

Grappling #

Breaking #

Kenpo Forms #

Traditional Forms #

Open Forms # (No Music)

Musical Forms #

TKD Forms #

Weapons # (No Music)

Musical Weapons #

Synchronized Forms #
(3 Minutes) # of players

Beg./Inter. Demo Team #
(4 Minutes) # of players

All Ages & Ranks
Demo Team #
(4 Minutes) # of players

Click here to read terms of Conditions and Liabilities

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CVN Number (last three digits on back of card)

Expiration Date

Name as it appears on Card

State* Zip Code*

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