|
|
|
|
Make checks payable to: Sex: Male Female Last 4 digits of SSN: __________ Age _________ Name: ____________________________________________ Street Address: _______________________________ City: __________________ State: _______ Zip:_____________ Phone number: ( )___________ E-mail address: ____________________ Credit card #:________________________ Exp date: ______ Date of birth: _____________________________ Team/School Affiliation: _______________________________ Category (circle one): Gi No-Gi Both Weight: __________ Experience: _______________ (Beginner, Intermediate, Advanced) Children pre-registered $45.00 (one division); $55 (two or more divisions) Children registration at door: $60.00 (one division; 70.00 (two or more divisions) Cash only - No checks or credit cards at the door. ***We will ATTEMPT to place children against each other by weight, age and experience. This is NOT GUARANTEED. 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 Nashville Grappling Open, Clay Enterprises and/or the venue in which it is held or 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: _____________________________________________________ |
