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 January 19 , 2010 If not Postmarked by January 19, 2010 then at the door fees will apply: First Event - $55.00 Additional Event - $30.00


Continuous Sparring	x $45.00	=
TKD Sparring	x $45.00	=
Grappling	x $45.00	=
MMA	x $45.00	=
Point Sparring	x $45.00	=
West Coast Sparring	x $45.00	=
Hard and 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	=
TKD Forms (Poomes)	x $45.00	=
Team Sparring (Per Person)	x $25.00	=
Coach Pass	x $20.00	=
Saturday Tickets	x $12.00	=
Video Pass ( 1 Day)	x $15.00	=
VIP Sseating ( 1 Day)	x $30.00	=
Coaches Pass	x $20.00	=
2009 World Championships Patch	x $5.00	=
Large Gear Bag	x $25.00	=
IMAC Memebership	x $25.00	=
Grappling Codes Adendem: "Grap1" Male - All Ages / All Ranks "Grap2" Female - All Ages / All Ranks
IMAC Rule Book	x $5.00	=
Total =
Additional Comments or Special Needs?








	TOTAL Enclosed	=

Division Numbers

Self Defense # / Handi-Capable

MMA # / Handi-Capable

Grappling # / Handi-Capable

Team Continuous Sparring #

Point Sparring #

*Continuous Sparring #

West Coast Sparring

*TKD Sparring #

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

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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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CASH ONLY AT DOOR