Paik’s Traditional Martial Arts Presents The

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12thAnnualCapitolCityClassicInvitationalTournament

USAKF North sanctioned event. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

At the VFW 301 Cottage Grove road Madison, WI

Sunday May 22nd, 2016 9:30 Registration/Sign in 10:30 Tournament Start

Form Weapons Form Sparring Team Events – Sparring, Forms

Competitors: $50(1-2 Events) $15 each additional.

($10 Late Fee at the Tournament) Team events $30/Team

Contact Information Grandmaster Peter S. Paik

601 N. Whitney Way Madison, WI 53705 (608)233-9999 or paikstmac@gmail.com

$100 Form Grand Champion!!!

12th Annual Capitol City Classic Open Martial Arts Championships

Sunday, May 22nd, 2016

Name:_______________________________ Age:____ Rank:________Weight:_______ Address:________________________________________________________________ City:_____________________________State:_____________Zip__________________ Phone: ( )______________________E-Mail:_________________________________ School:________________________________ Instructor’s Name:_________________ School Address:__________________________________________________________

Check which divisions you will be competing in : Traditional Forms _______ Open Forms _______ Weapons Forms _______ Point Sparring _______ Board Breaking – White belts only ________ $50 for first two events, $15 for each additional event, $30 for each Team Event ($5 late fee at the door) Total Fee Enclosed________ (Certified checks or Money orders) Mailed in registrations and checks must be postmarked by May 14th, 2016

Team Registration (Additional Event for those who are registered for Individual Competition) Team Name:____________________________ Sparring Forms Weapons Team Coach_________________ Representing______________________________ Competitors 1. _________________________ belt rank_______ Age___________ 2. _________________________ belt rank_______ Age___________ 3._________________________ belt rank_______ Age___________ Other (RESERVE)______________________________________________________ Entry fee=$30/team

Release form/ Waiver I agree to assume full responsibility for any and all damages, injuries or losses that I may sustain or incur while attending or participation in this tournament. I hereby waiver all claims against the promoters, operators, facilities or sponsors of the event for any claim for injuries that I may sustain. I fully understand any medical treatment given to me will be of FIRST AID TREATMENT only. _________________________ ____________________________________ ______________ Competitor’s Name Parent’s Signature (if competitor is under 18) Date