Houston International Karate Championships

Sensei D.E. Chambers, Chief Instructor .

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Discipline, Respect, Attitude, Self-Assurance, and most of all Honesty

HOUSTON INTERNATIONAL KARATE CHAMPIONSHIP TOURNAMENT

Online Registration [Return to Main Tournament Page]

Online Registration Form

Competitor Name:
Rank:
Home Address:
City:	State: Zip Code:
Phone Numbers:	Home: Work:
	Mobile:
E-Mail Address:
Date of Birth:	Age: Sex: Male Female
Height:	Weight:
Club/School Name:
Instructor:
Club/School Address:	(Include City/State/Zip)
Club/School Phone:

DIVISIONS: (Please indicate the division number and description of your divisions you are entering.)

Kata/Specialty:
Kata/Specialty:
Kata/Specialty:
Sparring:
Team Sparring:
Breaking:
Other Divisions:

Online Registration Fees:	Early Bird Pre-Registration Before March 28th	Pre-Registration By May 4th
One or Two Events	$45.00	$50.00
Each Additional Event	$10.00 x	$15.00 x
Jr. Team Sparring (per person)	$5.00	$7.00
Demo Team	$25.00	$35.00
Breaking	$30.00	$35.00
Continuous Sparring	$20.00	$25.00
Team Sparring	$50.00	$60.00
Adult Spectators	$10.00 x	$12.00 x
Child Spectators (5-Under)	$5.00 x	$6.00 x
TOTAL FEES:

PAYMENT METHOD:

Cash Check/Money Order Credit Card

If paying by cash, check, or money order, be sure to mail your payment to North Side Karate, 1100 Greens Pkwy, Suite 480, Houston, Texas 77067 prior to May 1st to avoid any registration delays. Please note that North Side Karate does not encourage sending cash payments via U.S. Mail.

ALL MAJOR CREDIT CARDS ACCEPTED!!!

You may use Visa, Master Card, and Discover Card on PRE-REGISTRATIONS ONLY! Checks only accepted before the May 6th deadline. All payments after May 7th, must be cash, cashier’s check, or money order only.

Name on Card:

Card Type:

Credit Card #: Expiration Date:

By submitting this online form, I agree to pay the above amount as a non-refundable charge to my credit card and I agree that I can not be charged back or cancelled without the express written consent of North Side Karate.

PAYMENTS: Make payable to N.S.K. Mail to : 1100 Greens Pkwy, Suite 480, Houston, Texas 77067. Cash only will be accepted at the door. Only U.S. Currency, Travelers Checks or Money Orders. NO REFUNDS, NO TRANSFERS, NO SUBSTITUTIONS.

Validation Code:

[Enter KARATE2012 above to help prevent Spam sent through our message server]

Your submission of this form electronically signifies your acceptance and agreement to the LIABILITY WAIVER & RELEASE.

LIABILITY WAIVER & RELEASE:

I, the sender, do hereby voluntarily submit my application for participation in the said martial arts tournament & hereby assume full responsibility for any and all damages, injuries or losses that I may sustain or incur, if any while attending or participating. I waive all claims for / or against the promoters, operators, or sponsors of said tournament, individually or otherwise for any claims for injuries that I may sustain. I fully understand that I am entering such competition at my own risk & that any medical treatment given to me will be of first aid treatment type only. I declare that I am free of any physical defects of illness which might prohibit competition. I consent that any pictures taken of me in connection with the tournament can be used for publicity, promotion, or television show & I waive compensation in regards thereto. If under 18 years of age, this release & consent for to be signed by a parent or guardian. I further agree to abide by the rules of the tournament & the final decisions of the officials. I certify that the above information is correct & accurate to the best of my knowledge. I further agree that any pictures taken of or by me in connection with said tournament can be used by the tournament producer or director for publicity, promotion without compensation at this time or any other time.

North Side Karate reserves the right to refuse admission to any spectator or competitor.