2007 HOUSTON INTERNATIONAL MARTIAL ARTS & USAWKF NATIONAL CHAMPIONSHIPS

August 3,- August 5, 2007Hotel Comfort Suites 4820 Techniplex Dr. Stafford, TX 77477

Competition Site: Stafford Centre 10505 Cash Rd. Stafford, TX 77477

REGISTRATION FORM (PLEASE PRINT)Deadline postmarked by July 14, 2007 (late fee: $15)

Section 1 – Personal InformationName:       School       Address:       Address:      

                                          City State Zip Code City State Zip CodePhone:       Sifu/Master       Age     Gender:    Yrs Exp:       Phone:       Email:       Email:      

Section 2 – Levels (Please mark only one) Section 3 – Divisions (Please mark only one)

Teens and Adults Beginner less than 2 years Intermediate 2 to 4 years Advanced more than 4 years

Divisions may be combined if there are 4 or less competitors

Pee Wee ages 6 – 8 Kids ages 9 - 11 Youth ages 12 - 14 Junior ages 15 - 17

Men Women Ages 18 - 25 Ages 26 - 35 Ages 36 - 45 Ages 46 - 55 Ages 56+

Section 4 – Internal Events Section 4 – External Events Sec 4 – Open Events Chen Tai Chi Yang Tai Chi Sun Tai Chi Wu Tai Chi Wu (Hao) Tai Chi 24-Step Tai Chi 42-Step Tai Chi 48-Step Tai Chi Lu Taiji Guang Ping Cheng Man Ching Other Forms

Xing Yi Ba Gua Liu He Ba Fa 42 Step Taiji Sword Tai Chi Straight Sword Tai Chi Saber Tai Chi Long Weapon Tai Chi Short Weapon Tai Chi Other Weapon

Traditional Kung Fu Northern Southern Short Wing Chun Form Saber Staff Spear Straight Sword North Praying Mantis Eagle Claw TaeKwon Do Form Choy Lay Fut Karate Form Other Weapon

Modern Wushu Changquan Nanquan Straight Sword Saber Staff Spear Nandao Nangun Other Form Other Weapons

Form Long Weapon Short Form Flexible Weapon 2-3 Man Fist Set 2-3 Man Weapon Self Defense

Applications

Section 5 – Group Events1 person registers 4 – 6 people per group

Taiji Form Group Name________________________ Taiji Weapon Group Name_________________________ Other Form Group Name________________________ OtherWeapon Group Name_________________________

Karate Form Group Name____________________ Karate Weapon Group Name____________________ TaeKwonDo Form Group Name___________________ TaeKwonDo Weapon Group Name___________________

Section 6 – Reaction Skills

Restricted Step Push Hands Moving Push Hands Point Sparring (17 & under) Continuous Sparring (Adult)

Shuai Chiao Chi Sau Weapons Sparring Sanshou

(Advanced Adult Only)

Age: 6 - 8 9 – 11 12-14 15-17

18-25 26 - 35 36 - 45 46 -55 56+

Gender:

Female Male

Weight:

____lbs

Section 7 – Grand Champion Competition Titles

Junior Grand Champion Internal Martial Arts Adult Grand Champion Internal Martial Arts Junior Grand Champion External Martial Arts Adult Grand Champion External Martial Arts

Junior Grand Champion Karate Junior Grand Champion Tae Kwon Do Adult Grand Champion San Shou

Must be Advanced Level Adult or Junior with more than 4 years experience! See website www.HIMAChampionships.com for rules and regulations for Grand Champion’s qualifications

Section 8 – WAIVERI,       , the undersigned, knowingly and without duress, do voluntarily submit my entry to the 2007 Houston International Martial Arts & USA Wushu KungFu Federation National Championships (HIMAC & USAWKF). I hereby assume all risk of physical and mental injuries, disabilities and losses, which may result from or in connection with my participation in the HIMAC & USAWKF seminars and competition events Acting for myself, heirs, personal representatives, and assignees, I do hereby release HIMAC & USAWKF, its officers, agents, representatives, servants, employees, volunteers, and all other related members from all claims, actions, suits, and controversies at law or in equity by reason of any matter, cause, or thing whatsoever that I may sustain as a result of or in connection with my participation in the seminars and competition events.

I also understand that participation in these seminars and competition events, especially but not limited to fighting point or full contact sparring seminars, entails a great risk of injury and I assume full responsibility for all my actions, intentional or otherwise, during and in connection with my participation in the seminar. I fully understand that any medical attention or treatment afforded to me by the HIMAC & USAWKF, its officers, agents, representatives, servants, employees, volunteers, and all other related members will be first aid type only, and I hereby release the HIMAC & USAWKF, its officers, agents, representatives, servants, employees, volunteers, and all other related members from any liability for such aid.

I agree that my performance, attendance, and participation at the Competition, Seminar may be filmed or otherwise recorded or telecast live. I consent to the use by HIMAC & USAWKF of my name, likeness, voice, poses, pictures, and biographical data concerning fully or in parts, in any form or language, with or without other material through the world, without limitation, for television, radio, video, theatrical motion pictures, or any other medium by devices now know or hereafter devised, and I do hereby waive any compensation in regard thereof as well as any future rights to the aforementioned.

I have read and fully understand the waiver listed above. I also understand that all fees paid are nonrefundable. Parent or legal guardian signature is required if participant is under eighteen (18) years of age.

________________________ __________________________ ___________________Participant Signature Parent/Guardian Signature DateSection 7 – Spectator Fees

One Day Pass (competition only) $15 X ___:  Two Day Pass (competition only) $20 X ___:  

MASTER'S DEMO (separate from 1 & 2 day passes) $15 X ___:  MASTER'S DEMO VIP SEAT $20 X ___:  

SANSHOU FIGHT (separate from 1 & 2 day passes) $10 X ___:  VIDEO PASS (competition only) $35 X ___:  

Total Spectator Fees  

Section 8 – Payment CASH REGISTRATION ONLY ON August 3 – 5 2007PLEASE MAIL FORM WITH CHECK OR MONEY ORDER MADE PAYABLE TO:

USA Chen Tai Chi Federation9730 Town Park Drive, Suite 116Houston, TX 77036 USAPhone 713 -270-6797Fax 713 774-8896

http://www.himachampionships.cominfo@himachampions.com

REGISTRATION FEE $30 (after May 30th $55)  (includes 1st INDIVIDUAL event)  

GRAND CHAMPION REGISTRATION $50 (after May 30th $90):(includes 1st INDIVIDUAL event)  

USACTC & USAWKF FEDERATION MEMBERS DISCOUNT - $10  # of additional events_______ X $10:  

# of team events_______ X $70:  Late Fee ($15 after July 14,2007)  

Total Spectator Fees (section 7)   TOTAL FEE