AUSTRALIAN KYOKUSHIN KARATE ASSOCATION INC.

AUSTRALIAN KYOKUSHIN KNOCKDOWN

Family Name: ………………………..Given Name: ……………………..

Address: …………………………………………………………………….

………………………………………………………….. Postcode: ………..

Telephone: Home ( ) …………………….. Work: ( ) …………………..

Date of Birth: ……/……/…… Age at 13/8/2000…….. Yrs. Grade: …..…..

Instructor: ………………………. Dojo (club) ……………………………

Martial Art Practiced: ……………………………………………………...

Approximate weight you will compete at (kg) : ……. Your height………

Gender Categories - Weight Divisions - Age Divisions:

It is the applicant's responsibility to ensure that they enter correct divisions relating to gender, weight, grade and age. If you enter a wrong category or division. You will only be able to enter another division if the draw provides the opportunity.

Your entry: (please circle the weight AND division you wish to enter)

WEIGHT DIVISIONS:

Male Lightweight 70kg & Under Female Lightweight 60kg & under.

Male Middleweight 70.01 - 80kg Female Middleweight 60.01-65kg

Male Heavyweight 80.01 & over Female heavyweight 65.01 & over

BELT DIVISIONS:

Blue Belt & Under: Yellow & Green Belt: Open:

Under 18 yrs Division: Male Division: Female Division:

(Male & Female Colts - weight & Belt divisions (if any) to be advised)

Tournament Organizers: The organizer of this tournament is the:

Australian Kyokushin Karate Association Incorporated.

17 Tamarama Marine Drive,

Waverley NSW Australia 2024

Tel. 02-93890252

WEIGH-IN: At the venue at 12 noon

MEDICAL DECLARATION. By signing this application the applicant hereby assumes full and total responsibility for his/her safety and personal possessions and the applicant releases the tournament organizers, agents, sponsors and other competitors from any liability, for any injury or personal loss of any kind whatsoever.

The applicant acknowledges that he/she understands the risks associated with comporting in this kind of karate tournament.

The applicant also gives his/her consent to receive medical treatment, which may be deemed (which will be of first aide type only) advisable in the event of injury, accident or illness sustained by the applicant during the said tournament.

COMPETITORS CODE OF ETHICS: Should my entry into this event be accepted I hereby declare that I will, at all times: Compete to the best of my ability; obey the rules of the tournament; obey the referee; display good sportsmanship and courtesy.

ENTRY FEE: An entry fee of $25.00 must accompany this application. Under no circumstances will the entry fee be refunded.

LATE ENTRY FEE: Entries received after the deadline date must pay an extra $25.00 late entry fee (total cost a late entry $50.00)

DEADLINE: Entries and entry fee must be received on or before the last mail on Friday 30^th July 1999.

SIGNATURE OF APPLICANT: ……………………………………………

If the applicant is under 18 years of age, the applicant's legal guardian must sign the application:

I certify that I am the legal guardian of the applicant:

Full name: ………..……………………………………………………………