Registration

First name

Last name

First name

Last name

Email

Gender

Male Female

Birthday

Address

Street Address

Street Address 2

City

State / Province

Postal / Zip Code

Country

Experience Level

Years

Months

First Timer

Yes No

Weight (kg)

Name of Martial Arts School

If not applicable, please type none

Name of School

Name of Instructor

If not applicable, please type none

Name of Instructor

Name of Team

Only required if you are participating in the Lion Dance Event.

Name of Team

School Email

School Phone#

School Phone

Address

Street Address

Street Address 2

City

State / Province

Postal / Zip Code

Country

Yes No

PLEASE FILL OUT THE FIELDS BELOW.

Have you been a victim of a knocked out in the last 90 days? If so, please describe:

Yes No

What is your record? [WINS-LOSSES-TIES]

Record

Are you a professional fighter?

I understand that professional fighters are not allowed to fight in amateur tournaments. I hereby declare that I have never fought as a professional fighter in any combat sport.

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PHOENIX WUSHU NATIONALS REGISTRATION

COMPETITOR INFORMATION

Name

If Under 18, Full Name of Legal Guardian

Email

Gender

Birthday

Address

City

State / Province

Postal / Zip Code

Country

Experience Level

First Timer

Weight (kg)

T-Shirt Size

SCHOOL INFORMATION

Name of Martial Arts School

Name of Instructor

Name of Team

School Email

School Phone#

Address

City

State / Province

Postal / Zip Code

Country

ARE YOU PLANNING TO PARTICIPATE IN CHINESE KICKBOXING?

PLEASE FILL OUT THE FIELDS BELOW.

Have you been a victim of a knocked out in the last 90 days? If so, please describe:

Describe your knock out.

What is your record? [WINS-LOSSES-TIES]

Are you a professional fighter?