Canada Cup 2014
Individual Registration Form

 

First Name* Last Name*

Dojo*       Province*

Phone* ( ) - -        Phone (other) ( ) - -

eMail*

Gender* M F       Birthdate*    Age as of May 17, 2014

Rank*

Tournament $35 Kata   Kumite

Training Clinic $30
Judge Clinic $25 Judges Exam $80
Kenchusei Credit (instructors class)$20
Dan Testing (Exam Fee Only)
Banguet Tickets Adult (age 13+) $57
Banquet Youth (12 and under) $30
Late Payment Fee (after May 1)
Final Total

Medical Form Completed & Signed
Waiver Form Completed & Signed

I have checked & verified the above information and now wish to submit it Yes No