2024 Registration Form

FIESTAS 51th ANNUAL INTERNATIONAL KARATE-DO CHAMPIONSHIPS

International Karate-do Shito-Ryu Federation
Name*

First NameLast Name
Age*
Birthday*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number*

Area CodePhone Number
Dojo
Instructor
Dojo Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Rank
Style
Kumite Event #
Kobudo Event
Team Event #
Select One

One Individual Event $90.00Two Individual Events $105.00Three Individual Events $120.00
Team Event

Team Event $75.00
Dinner to honor Shinan Juan Larios 09/16

Dinner $75 per Person
Spectators $10 each
Total for event

Payment Information

USDDescription

Payment Methods

Credit Card

Google Pay

Cash App Pay

Release, waive, discharge and covenant not to sue the INTERNATIONAL KARATE-DO SHITO-RYU FEDERATION or the SOUTH GATE SPORTS CENTER, its officers, its affiliated club, regional sports organizations, their respective administrators, agents, coaches, and other employees of the federation, other participants, sponsoring agencies, sponsors, advertisers and is applicable, owners and leases of premises used to conduct the event, all or which are hereinafter refer to as “releases” from any and all liability to each of the undersigned, his or hers and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property; caused or alleges to be caused in whole or in part by the negligence of the release or otherwise. I understand that any medical treatment given will be of a first aid treatment type only.

ALL ENTRIES ARE FINAL. NO REFUNDS WILL BE GIVEN!

NO CHECKS ON TOURNAMENT DAY. NO EXCEPTIONS!

If under 18, this form is to be signed by a parent or guardian.
Signature of contestant*

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Signature of parent or guardian

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Kata Event #
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