Mu Alpha Xi
Martial Arts Championships
Pre-registration Form
Name of Participant_________________________
Address___________________________________
City_________________ State_____ Zip_________
Phone #_________________________________
Age____ Sex____(M or F)
E-mail (optional)____________________________
Style______________________________________
Dojo______________________________________
Rank______________________________________
Years Practicing_____
Check events you will be participating in (estimate):

Open Demonstration Event __

Grand Champion Events are free for those that qualify.
Number of events Participating in______
1 Event $25 2 Events $30 All Events $35
Amount Enclosed_______
Please make all checks payable to: President Matt Hayes.
Please pre-register to recieve special prizes.

Sponsorships are available. Please call President Matt Hayes (209) 743-8326

Please read and sign below waiver.

I understand that there is an inherent risk that goes along with the practice of martial arts. Even practicing alone can lead to serious injury or even death and no amount of skill can guarantee complete safety. If I compete in sparring there is a good chance I may get hurt at some point, and I will remember to forgive the trespasses of my competitor. He is my brother in martial arts and I might be the one to accidentally hurt him. Furthermore I understand that these accidents do happen, and I will not bring any suits at law or equity against anyone involved in the event. I, the undersigned assume all risks of personal injury during or in transit to/from event. I release the university, the fraternity, judges, officials, sponsors, and all other persons/organizations involved, from all liability, including suits at law or in equity, for any injury which may result from my decision to participate in said event.

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Signature of contestant Date

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Signature of Parent/Guardian Date (if under 18)

The Brotherhood of Martial Artists Welcomes You!