Your Information
*Competitor's First Name:
Male
Female
*Competitor's Last Name:
*Date of Birth
*Age
*Martial Arts
School:
*Rank:
(Example: Yellow Belt / 9th Kyu, 3rd
Dan, etc.)
*Instructor
Telephone:
Address/Line
1:
Address/Line
2:
City:
State/Territory/Province:
Zip/Postal
Code:
Country:
*E-mail
Address:
Guardian's Name
(Only
if competitor is under the age of 18)
Please Mark
divisions that You are Entering
Division Code:
UMAHoF World
Championships
Example: {
BF- 01 }
Please Check the
appropriate category that you are
participating.
Kumite
(Fighting)
Kata
( Forms)
Speciality
Newza
(Submission)
Shuai Chiao
(Padded Staff & Sword)
Area for
additional information or instructions
Kumite
(Fighting)
F-01
- 5 & Under - All Belts
F-02
- 6-7 Beginner
F-03
- 6-7 Intermediate
F-04
- 6-7 Advanced
F-05
- 8-9 Beginner
F-06
- 8-9 Intermediate
F-07
- 8-9 Advanced
F-08
- 10-11 Beginner
F-09
- 10-11 Intermediate
F-10
- 10-11 Advanced
F-11
- 10-11 Black Belt
F-12
- 12-13 Beginner Girls
F-13
-
12-13 Beginner Boys
F-14
- 12-13 Intermediate Girls
F-15
- 12-13 Intermediate Boys
F-16
- 12-13 Advanced Girls
F-17
- 12-13 Advanced Boys
F-18
- 12-13 Black Belt Girls
F-19
- 12-13 Black Belt Boys
F-20
- 14-15 Beginner Boys
F-21
- 14-15 Intermediate Boys
F-22
- 14-15
Advanced Boys
F-23
- 14-15 Black Belt Boys
F-24
- 14-17
Beginner Girls
F-25
- 16-17 Beginner Boys
F-26
- 14-17 Intermediate Girls
F-27
- 16-17 Intermediate Boys
F-28
- 14-17
Advanced Girls
F-29
- 16-17
Advanced Boys
F-30
- 14-17 Black Belt Girls
F-31
- 16-17 Black Belt Boys
F-32
- Adult Women Beginner
F-33
- Adult
Women Beginner
F-34
- Adult Men Beginner Lt. Weight (160# &
Under )
F-35
- Adult Men
Beginner Mid. Weight (161#-185# )
F-36
- Adult Men
Beginner Hvy. Weight (186# & Up )
F-37
-
Adult Men Intermediate Lt. Weight (160# &
Under )
F-38
-
Adult Men
Intermediate Mid. Weight (161#-185# )
F-39
-
Adult Men
Intermediate Hvy. Weight (186# & Up )
F-40
-
Adult Men Advanced Lt. Weight (160# &
Under )
F-41
-
Adult Men
Advanced Mid. Weight (161#-185# )
F-42
-
Adult Men
Advanced Hvy. Weight (186# & Up )
F-43
- Executive Men Beginner (Age 35 &
Up)
F-44
-
Executive Men Advanced (Age 35 &
Up)
BF-01
- Blk Belt Men Lt. Weight (160# &
Under )
BF-02
- Blk Belt Men Mid. Weight (161#-185# )
BF-03
- Blk Belt Men Lt. Weight (186# & Up )
BF-04
- Blk Belt
Women Fly Weight (125
& Under )
BF-05
-
Blk Belt
Women Lt. Weight (126 & Up )
BF-06
- Blk Belt Executive Women ( Age 32 &
Up )
BF-07
- Blk Belt Executive Men (Age 35 & Up )
BF-08
- Blk Belt Exec. Men/Women (Age
45 & Up )
UNSELECT
Kata
(
K-01
- Little Dragon DEMO
K-02
- Physically Challenged
K-03
- 5 & Under - All Belts
K-04
- 6-7 Beginner
K-05
- 6-7 Intemediate
K-06
- 6-7 Advanced
K-07
- 8-9 Beginner
K-08
- 8-9 Intermediate
K-09
- 8-9 Advanced
K-10
- 10-11 Beginner
K-11
- 10-11 Intermediate
K-12
- 10-11 Advanced
K-13
- 10-11 Black Belt
K-14
- 12-13 Beginner
K-15
- 12-13 Intermediate
K-16
- 12-13 Advanced
K-17
- 12-13 Black Belt
K-18
- 14-15 Beginner
K-19
- 14-15 Intermediate
K-20
- 14-15 Advanced
K-21
- 14-15 Black Belt
K-22
- 16-17 Beginner
K-23
- 16-17 Intermediate
K-24
- 16-17 Advanced
K-25
- 16-17 Black Belt
K-26
- Men Beginner
K-27
- Men Intermediate
K-28
- Men Advanced
K-29
- Women Beginner
K-30
- Women Intermediate
K-31
- Women Advanced
K-32
- Excutive Beginner
K-33
- Excutive Advanced
BK-01
-
Black Belt Men
BK-02
-
Black Belt Women
BK-03
- Black Belt Exec. Men
BK-04
- Black Belt Exec. Women
BK-05
-
Black Belt Soft & Hard Style (18-35)
BK-06
-
Exec. Black Belt Soft & Hard Style (35 &
up)
BK-07
- Masters (5th Dan-10th Dan)
BK-08
-
Black Belt Traditional
BK-09
-
Black Belt Self-Defense
BK-10
- Blk Belt Sr. Exec. Men/Women (Age 45 &
Up)
UNSELECT
Specialty
(Forms)
S-01
- Specialty 12 & Under Beginner
S-02
- Specialty 12 & Under Advanced
S-03
- Specialty 12 & Under Black Belt
S-04
- Specialty 13-17 Beginner
S-05
- Specialty
13-17 Advanced
S-06
- Specialty 13-17 Black Belt
S-07
- Specialty Adult (Beginner,
Intermediate, Advanced)
S-08
- Specialty
Adult Black Belt
S-09
- Physically Challened
S-10
- Breaking
S-11
- Self-Defense
S-12
- Continuous Sparring
(Black Belts Only)
UNSELECT
Newza
(Submission)
G-01
-
Youth with Gi
G-02
-
Youth without Gi
G-03
-
Women with Gi
G-04
-
Women without Gi
G-05
-
Men
with Gi
G-06
-
Men without Gi
G-07
-
Executive men with Gi
G-08
-
Executive men without Gi
UNSELECT with Gi
UNSELECT without Gi
***Note***
Shuai Chiao
(Padded Staff & Sword)
PSS-01
-
5 & Under
PSS-02
-
6-8
PSS-03
- 9-11
PSS-04
- 12-14
PSS-05
- 15-17
PSS-06
- 18-34 Beginner
PSS-07
- 34 & Up Beginner
PSS-08
- 18-34 Intermediate
PSS-09
- 34 & Up Intermediate
PSS-10
- 18-34 Advanced
PSS-11
- 34 & Up Advanced
UNSELECT
Some Division may run concurrent with other divisions. Especially if you are
entering the submission division. Please coordinate with your Ring Judge to avoid disqualification.
Complete Release of Liability
I the undersigned, do hereby
voluntarily submit my application in the
Universal Martial Arts Hall of Fame,
Inc. and hereby assume full
responsibility for any and all damages,
injuries, or loss that I may sustain or
incur, if any, while attending or
participating in this event. I waive all
claims for / or against Professor
Silverio Guerra, Master Adam Guerra,
Grand Master Daryl K. Stewart, Master
Walt Lysak, Grand Master Ovid Rodriguez,
Master Richard Ryan, Earl Portnoy, Tom
Shamuon, Tournament staff Sheraton North
Hotel, Individually or otherwise for any
other claims for injuries that I may
sustain. I fully understand that I am
entering into a fighting competition at
my own risk and that any medical
treatment given will be on first aid
treatment only. I declare that I am free
of any physical defects or illness that
which might prohibit competition. I
consent that any pictures furnished by
me or taken in connection with the
tournament can be used for publicity,
promotion, or television. I waive
compensation in regards thereto… If I am
under 18, this release and consent is to
be signed by parent or guardian. I
further agree to abide by the rules of
the tournament and the final decisions
of the officials.
ENTRY FEE:
$50 One Event - $10 Per
additional event.
(Excludes
Submission Wrestling)
(Excludes Submission Wrestling)
ENTRY FEE: RECEIVED AFTER
June 15th (Excludes
Submission Wrestling)
SPECTATOR FEE:
$10.00, $3.00 (8 & under)
Paid at the door
only
VIDEO PASS FEE:
$20.00
Paid at the event
only
Friday
Night Registration 7:00 P.M. @
HotelSHARP!!! SHARP!!!
Card Details
Card Information
as displayed on bill (Needed
for Owner Verification )
*First Name:
*Last Name:
*Address/Line
1:
Address/Line
2:
*City:
*State/Territory/ Province:
*Zip/Postal
Code:
There is a
3% Credit card Processing Fee
with a credit card purchase.
Questions Click Here.
Submission
First Divisions Entered
Submission
Second Divisions Entered
Karate Divisions Entered
0
$51.50
$61.80
1
$51.50
$103.00
$113.30
2
$51.50
$103.00
$113.30
3
$61.80
$113.30
$123.60
4
$72.10
$123.60
$133.90
5
$82.40
$133.90
$144.20
6
$92.70
$144.20
$154.50
7
$103.00
$154.50
$164.80
Click
Submit if you have read and understand the
"COMPLETE RELEASE OF LIABILITY"
I certify
that the above information is correct
and accurate to the best of my
knowledge.
If you
are having problems submitting this
form. When you submit form you get
an error and the field is not left
blank. If the field that is causing the
error does not apply please enter either
00 or XX. If this this does not
correct the problem please sent a brief
email to
umahofpubdir@sbcglobal.net
explaining the error given. If
possible list the field causing the
problem and the data to be entered.
We apologize for any inconvenience this
has caused you.
Click
Clear Form if you do not accept the terms of
the "COMPLETE RELEASE OF
LIABILITY"
Thank You for entering into the
prestigious event!!!
No
checks on day of tournament.
U.S. Currency,
Credit Cards,
Travelers checks, Money orders, and
Certified checks only.
Not responsible
for lost mail. No Refunds.
