Clutch City Classic 2018

Clutch City Classic - Sat. Nov. 3rd 2018

Fill out the form to register to our event
Participant's Name *

First Name Last Name
Date of Birth

- Month - Day Year
Date
Age

Address *

E-mail *
Phone Number *

- Area Code Phone Number
Belt Rank *
School *
Tournament Fees - **You will be sent an invoice via email to pay
3 Events for $45
Select Events - $45 for 3 Events *

Forms Sparring Breaking
*Please select how many sets of boards ($10 -1 Set = 3 boards)
Extras - Select All That Apply

Weapons - $5 (Red belts and higher only) Team Forms - $5 per participant (teams of 3 for red belts and higher only)
I, the undersigned, do hereby voluntarily submit my application for attendance and participation in Momentum Karate & Fitness Clutch City Classic Tournament and I do hereby assume full responsibilty for any and all damages, injuries, or losses that I may incur or sustain while in attendance or participation. I further waive all claims against the promoter, operator, sponsors, students, and parents of Momentum Karate & Fitness for any injuries or losses that I may incur. I also grant Momentum Karate & Fitness permission to use any pictures taken of me at this event.
Signature

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Date

- Month - Day Year
Date
Total

USD Description
Total
After reviewing your submissions, you will be redirected to PayPal for payment. If you do not have a PayPal account or would like to make a different type of payment, please call us at 832-813-5869. You will NOT need to resubmit your information again.
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Clutch City Classic - Sat. Nov. 3rd 2018