SILVER STATE OPEN INDIVIDUAL & TEAM ENTRY APPLICATION

INSTRUCTIONS: Please read all information carefully. Must print legibly. Waiver of injury must be signed. All events must be correctly entered. Failure to complete all instructions will result in an unprocessed application. Fill in the Registration Form, submit it, then print and mail a copy with your check or money order made payable to "Ross Briggs, 15 Alexis Court, Sparks, NV 89436. For you to be Pre-registered your form and money must be mailed and received no later than Monday, April 24, 2006. Pre-Registration Fees: 1st Event $30.00, all other events $10.00. At the Door Fees: 1st event $40.00 all other events $15.00. Spectators 5 and over are $5.00.

INDIVIDUAL APPLICATION
Please print clearly. Each Team Member must fill out a separate application

Last Name  First Name 

Birthday  Age    Sex  M F Height  Weight

Address City

State   Zip   Phone: FAX:

Email:   Dojo/School Address

Style   Rank

How would you rate your health:  Excellent Good Fair Poor

TEAM APPLICATION
All 5 members must fill application out completely. Event code and signature is mandatory and acknowledges that individual has read and understands waiver, and thereby agrees to take responsibility.

Last Name  First Name 

Birthday  Age    Sex  M F Height  Weight

Applicant/Parent Signature 

Last Name  First Name 

Birthday  Age    Sex  M F Height  Weight

Applicant/Parent Signature 

Last Name  First Name 

Birthday  Age    Sex  M F Height  Weight

Applicant/Parent Signature 

Last Name  First Name 

Birthday  Age    Sex  M F Height  Weight

Applicant/Parent Signature 

Last Name  First Name 

Birthday  Age    Sex  M F Height  Weight

Applicant/Parent Signature 

REGISTRATION INFO
NO ONE WILL RECEIVE UNATTACHED WRISTBANDS

NO REFUNDS FOR MISSED EVENTS, DISQUALIFICATION OR INJURY!

PRE-REGISTRATION: Contestants may pre-register and save $5.00 per event by mailing their completed application to the SILVER STATE OPEN, 15 Alexis Court, Sparks, NV 89436 no later than April 12, 2004.
REGISTRATION: Contestants who are unable to pre-register may register at BOOMTOWN HOTEL & CASINO the morning of the tournament. Saturday April 24, 2004. Money orders or cashiers checks made payable to Ross Briggs, or cash is accepted. NO PERSONAL CHECKS. Pre-Registration Fees: 1st Event $30.00, all other events $10.00. At the Door Fees: 1st event $35.00 all other events $15.00. Spectator Fees: Adults and Children over 6 are $5.00. Children 6 and under FREE.

WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT.
NO REFUNDS FOR MISSED EVENTS OR INJURY!

I the undersigned, hereby release the Silver State Open Martial Arts Tournament, Ross or Georganna Briggs, the event sponsors, volunteers and staff, tournament promoters and any and all other persons associated with this event in any capacity, from any and all liability due to injuries up to and including death that I may sustain or incur as a result of my attendance, travel to or from, and/or participation in any Silver State Open Martial Arts Tournament event. Furthermore, I hereby waive any compensation whatsoever for the use of pictures, video or film production of myself, utilized by those associated with this event, for any profit-making at any time now and in the future. I understand that I am entirely responsible for obtaining permission from the artist(s) for any music I use for my competition or otherwise, and verify by the signing of this, that I have done such. I agree to indemnify, defend and hold blameless all of the above named parties & persons from any liability or compensation for use of such music and further state that the above named parties & persons may use such music in any recorded performances of myself for profit making purposes, at any time. I clearly understand that the sparring aspect of this sport and competition involves bodily contact. Additionally, I am fully aware of my personal medical condition and hereby certify that I am mentally and physically fir to compete at this and any other Silver State Open Martial Arts Tournament, events. I have read and understand and agree to abide by the rules associated with the above listed events and assume any and all associated liability for infringement of such rules. I further agree to indemnify, defend and hold blameless all of the above named parties & persons from any litigation against the same.

ENTER BY DIVISION CODE

DIVISION FEE
1.  $ 
2.  $ 
3.  $ 
4.  $ 
5.  $ 
TEAMS
1. $
SUB-TOTAL $
TOTAL $ 

Applicant's Signature   Date 

Parent's Signature   Date 

Competitor or Parent / Guardian Signature Assuming Responsibility if under 18.