Make checks payable to:
Clay Enterprises
613 Durrett Drive
Nashville, TN 37211
615-834-7927
Sex: Male Female
Last 4 digits SSN#: ________________
Name: ____________________________________________
Street Address: _______________________________
City: __________________ State: _______ Zip:_____________
Phone number: ( )___________
E-mail address: ____________________
Credit card #:________________________ Exp date: ______
Date of birth: _____________________________
White and Blue Belt Weight Divisions: Under 150 150.1-163 163.1-175 175.1-187 187.1-205 205.1-215 215.1 and up
Purple, Brown and Black Belt Weight Divisions: Under 175 Over 176
Team/School Affiliation: _______________________________
Date you started training Month______________ Year_______
Category (please circle): Gi No-Gi Absolute
Gi Division (please circle one): White Blue Purple Brown Black
No-Gi Division (circle one): Beginner Intermediate Advanced
Amount paid if pre-registered $55 (1 division); $65 (2 divisions) $75.00 (3 divisions)
Amount paid at door: CASH ONLY $70 (one division); $80 (two divisions) $90.00 (3 divisions)
I, the applicant, do hereby for myself, my heirs, executors and administrators and/or assigns, do waive release and forever discharge any and all rights and claims for damages which I may have or which here-in-after occur as a result of my participation in The Music City Grappling Championship and/or Franklin Road Academy, Ed Clay, Regina Clay, or Frank Mullis which may arise out of my travel to, participation in, or return from such endeavor. I understand that serious injuries may result from my participation in this competition and my signature attests to my knowledge and assumption of ALL risks. I understand that I have been advised to contact legal counsel if I do not understand the nature and legal effects of this FULL and FINAL RELEASE.Signature: _____________________________________________________