BeachBlast Open

BEACH BLAST OPEN REGISTRATION

February 27nd and 28rd 2009

For Additional Info


Online Registration is Fast and Easy, just follow these simple steps:

	Complete the general information below and accept the waiver as indicated

	Enter the names of the competitors

	Select the events for the first competitor

	Select the events for additional competitors (if applicable)

	Review events and fees

	Pay via credit card or PayPal


	NOTE: you may exit the registration process anytime!
	For additional information contact:andrea@beachblastopen.com

Responsible Party Information

Last Name :
First Name and M.I :
Age :
DOB :
Address :
City :
State :
Zip :
Country :
Phone :
Belt Color :
Gender :	Male Female
Category :	Beginner Intermediate Advanced Black Belt
School :
Instructor :
E-mail :
No. of Participants:	for Individual event
PLEASE READ AND ACKNOWLEDGE THE WAIVER BELOW
All participants under 18 years of age must have parent/guardian’s signature. The participant/parent/guardian agrees to comply with the rules of the Beach Blast Open Martial Arts Championship. Participant/Parent/Guardian acknowledges that competition in this event involves physical contact and other activity Which may cause injury to the participant. In consideration for allowing Participant/ Parent/Guardian to compete in this event, Participant/Parent/Guardian hereby releases and waives any and all claims or causes of action against WCMAO, KIAI, and Wyndam Hotel, their directors, officers, employees, agents, and/or their insurance carriers, or any other person connected with the Beach Blast Open including but not limited to Lee Peregoff and Ken Morgan, for any injuries of whatever nature the Participant may sustain while participating in, spectating, attending and/or leaving the Beach Blast Open Martial Arts Championship. Participant/Parent/Guardian acknowledges that he/she/his or her child has had and passed a complete physical examination from a licensed physician within the past 12 months and that the participant is physically and mentally fit to participate in the Beach Blast Open Martial Arts Championship. Should any liability be imposed upon WCMAO, KIAI, and Wyndam Hotel, their directors, officers, employees, agents, and/or their insurance carriers, or any other person connected with the Beach Blast Open Martial Arts Championship including but not limited to Lee Peregoff and Ken Morgan, by a court of competent jurisdiction, it is expressly agreed that the amount of such liability shall not exceed the out of pocket costs for medical treatment or $2,000.00, which ever is less. All monies paid are non refundable. Lastly, participant/ parent/guardian hereby waives any compensation whatsoever for use of Pictures, videotape, media coverage, statements, interviews, etc., utilized by those producing or directing this event at any time.
Competitor’s Name :	(Parent or Legal Guardian if under age 18 years old )
WE HAVE THE RIGHT TO REFUSE YOUR PARTICIPATION FOR ANY REASON AND THE RIGHT TO ASK YOU TO LEAVE THE TOURNAMENT

For Additional Info