The Las Vegas
International Karate Championships
2010  Registration Form 

Name:
Address:
City: State:
Zip: Country:
Birthday:         Age:
Weight: Rank:
   Male:        Female:

Email:


School: Instructor:
Web Page:
Address:
City: State: Zip: Country:

Application date:   Month:   Day:

Package Fees
Package: (A,B,C,D,E,F)
See Fees for Package Descriptions and Prices

$

   Seminar Only Packages
Ten Seminars: $130 $    Eight Seminars: $100 $   Six Seminars: $80 $
One Seminar: $25 $      Additional Seminars: $15 each $     No Seminars

$
 ID          Amount
$ 
$ 
$ 
$ 
$  
$ 

Individual Events

First 2 Events are included in Package A or B then, $20 each additional event.

Or, $50 first event then,$20 each additional event.

(See Divisions for Event ID's.)

Dinner Tickets
   Additional dinners, adult: $
   Additional dinners, child: $
   Adult Dinners $50  Children $40

   Spectator Only Tickets
          Friday:  $ $20
Thurs, Sat:  $ $10 per day

Dinners:
$

Events:
$

Spectators:
$

Team ID       3 Person Team   Pre-pay  Pay at Tournament    $120 per team  

$

Friday IKKA Black Belt Testing: $ 100               

$

Don't Calculate          Check #     Total Amount Due: $


Make payment at the door, or by PayPal - (no mail-in applications after October 1, 2010)
Make Money Orders or Cashiers Checks (no checks after October 1, 2010) payable to:   Gilbert Velez


THERE ARE NO REFUNDS ON ANY REGISTRATION.

 

 ___________________________________________ _________
SIGNATURE OF PARTICIPANT / ATTENDEE           Date 

___________________________________________ _________
SIGNATURE OF PARENT / LEGAL GUARDIAN        Date
(All competitors under the age of 18 must have their registration form signed by a parent or legal guardian.)


READ AND SIGN: By signing the registration form, you here by acknowledge and understand that participating in a martial competition (Las Vegas International Karate Championships, Las Vegas IKC) is a physical activity (including, but not limited to competition, demonstrations, and spectating) and can lead to injuries. Being fully aware of the risks involved, attendees do hereby expressly assume all risks of injury or other damages related to his or her participation in or attendance of the LasVegasIKC and forever releases from any and all liability for injury or damages related to his or her participation in or attendance of the LasVegasIKC, the following entities and persons: Gilbert Velez, Las Vegas IKC Management, Palace Station Hotel and Casino, and staff members employed by or volunteers by same entities and persons. The signed attendee voluntarily waives all rights to seek compensation from any of the above parties for accidental of negligent in tort or contract resulting in any way from his or her participation or attendance of the LasVegasIKC. The sufficiency of which as consideration is hereby acknowledged for attendee’s signature. The attendee grants to the LasVegasIKC, and Gilbert Velez the unrestricted rights to record, edit, and compile performances and likeness and sell, distribute or otherwise utilize the recording in any manner desired by those parties, and expressly waive all rights to seek compensation from those or any other parties for the attendees likeness, voice and or performance at the LasVegasIKC.

 

   

 


Other Registration Options are Available.

 

Home ] Schedule ] Seminars ] Registration ] Fees ] Divisions ] Ring Assignments ] Hotel Info ] Pictures ]

For more information, email...  Info@LasVegasIKC.com

www.LasVegasIKC.com      www.InternationalKarateChampionships.com

Kenpo Karate in Tucson, AZ -  www.VelezKenpo.com

Page last updated: October 06, 2010
THE CONTENTS  (except the Kenpo patch), ALL GRAPHICS, AND ARTWORK ARE COPYRIGHT 1999-2010 BY MR. GILBERT VELEZ