Registration
Please register for this event using the form below:

Name	*
E-mail	*
Competition Event	*	Breaking Boards (Black Belt Only) Forms WTF/Tae-Guek Forms ITF/ other Sparring Check if Black Belt Competing in division different that, or in addition to actual age division Check if Black Belt that has competed in or placed at a National Event
Athlethes	*	1 or 2 Events $60 3 Events $75 4 Events $90 1 or 2 Events -MSTO member $50 3 Events -MSTO member $65 4 Events -MSTO memeber $80
Date of Birth	*
Age	*
If you have a MO State TKD Organization Member Number Please Provide
Height	*
Weight	*
Dan
BELT RANK - please select the category that best describes your rank mark the appropriate box	*	Beginner (white, yellow; 10th, 9th, 8th, 7th Geup) Intermediate (green /blue; 6th, 5th,4th Geup) Advanced (blue/red 3rd, 2nd, 1st Geup) Black (1st Dan) Black (2nd Dan) Black (3rd Dan) Black (4th Dan)
Gender	*	Male Female
Home Address	*
City	*
State	*	- - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip	*
Phone	*
School Name	*
Instructor's Name
Instructor's Email
Date	*
LIABILITY WAIVER: In consideration of your acceptance of my entry, I do hereby waive and release, for myself, my heirs and executors and administrators, any claim I may make against Stars and Stripes Taekwondo Championships, Pruter’s U.S. Martial Arts Center’s, South Valley Junior High School, the sponsors, directors, volunteers and competitors for any and all damages which may be sustained by me in connection with my association with or entry in the above athletic meet, or which may arise out of traveling to, participating in and returning from this athletic meet. I understand that Taekwondo is a body-contact sport which involves risk of injury. I understand all the contents of the rules and general information published by the sponsors and I agree with them in their entirety. I fully understand that any medical treatment I receive will be of the “First Aid” type only. In addition, I consent that any pictures taken of me in connection with this event can be used for publicity, etc. and I waive compensation in regard hereto. I agree to cooperate with all Stars and Stripes Championships staff, officials and security at all times. I agree to leave the competition floor at the conclusion of my contestants’ match(es).
Athlete Signature (enter name)	*
Contestants under age 18 require parent/legal guardian signature