2004
IKF
Amateur North American Classic
REGIONAL EVENT
REGISTRATION FORM
Please be aware of the Required Cornerman & Trainers Registration
and Event Pass Fee Due At Event Weigh-ins.
CLICK HERE!
- To Register: Print Form, Complete
&
MAIL to your IKF Regional Director/Promoter in your
REGION
with Fee of $35.00. ($15 will go to
IKF & $20 to your Regional Director/Promoter.)
- ALL FIGHTERS: Please Include a HEADSHOT Photo.
- PLEASE PRINT NEATLY
- Registration Forms "Without Fees" will be Disposed of.
- There are NO Registration Fee REFUNDS.
PAGE 1 Of 2
- What REGION
Are You Registering For: _____________________________________________
- FIGHTERS
Name:_____________________________ HOMETOWN: ________________________
- Current Age: ____ &
Birthday (month, day & year): ___/___/___
- Height in Feet & Inches:____'____"
- Weight in Pounds You Will Fight At:
______
Lbs.
- FIGHTERS MAILING Address: ______________________________________
- City: _______________________
State: _____________ Zip Code: _______________
- Country: _____USA, _____Canada, _____ Mexico. -
Zip or Postal Code: _______________
- FIGHTERS Phone Number:
_____________________ Fax: _______________________
- TRAINER: (SELF if you train yourself)
______________________ Gym Name: __________________
- TRAINERS MAILING Address:_______________________________________________
- City: _______________________
State: _____________ Zip Code: _____________
- Country: _____USA, _____Canada, _____ Mexico. -
Zip or Postal Code: _______________
- TRAINERS Phone:________________
Fax: ________________ e-Mail (If
One):_________@_______________
- FIGHT RECORD: W=Wins, L=Loses,
D=Draws, KO'S & TKO's=Knockounts or Technical Knockout.
- W:___ L:___ D:___ KO'S/TKO's:___
AM BOXING, If any: W:___ L:___
D:___ KO'S/TKO's:___
- Last Bout: Opponents Name: ___________________ Where:___________________________
- Date of Bout:___/___/___ Result
(Win or Lose, type of decision): _________________
PAGE 2 Of 2
RELEASE FROM LIABILITY
This RELEASE
of Liability is a Legal Contract binding upon You, The IKF (International
Kickboxing Federation) and any and all of the companies, federations or
organizations associates, officials, employees and staff. READ IT CAREFULLY AND
OBTAIN LEGAL ASSISTANCE IF YOU DO NOT UNDERSTAND IT.
- Voluntary Application. I, the undersigned,
acknowledge and state that I have voluntarily applied to compete in the 2004
IKF Amateur North American Classic Kickboxing Championships on August 13th,
14th & 15th at the Wyndham Palace Resort and Spar in Orlando, Floridaa,
USA.
- Assumption of risk. I am aware & understand
that in general, full contact fighting is a dangerous & hazardous activity, &
in particular, the techniques & methods of this convention, all in which as
a competitor in this competition, I shall be participating, is an extremely
dangerous & hazardous event. I am voluntarily & of my own free will
submitting an application to compete in this event with full knowledge &
understanding of the hazards involved. I hereby consent & agree to
completely accept alone any & all risks of injury or death, & I verify &
confirm this statement by placing my initials here: _____
- Release: In consideration for (a) being accepted
as a competitor of the 2004 IKF Amateur North American Classic Kickboxing
Championships, (b) being entitled to participate in activities conducted
and sponsored by the IKF (International Kickboxing Federation and (c) being
permitted to use facilities and equipment, whether owned or leased by The IKF
and all associates, officials, employees, staff, TKO Sports Group Inc., Wyndham
Palace Resort and Spa and fellow participants and trainers/coaches. I hereby
agree that I, my heirs, distributees, guardians, successors in interest and
legal representatives (collectively referred to as "Releasor")
will not make a claim or file an action or suit against, sue, or attach the
property of (a) the 2004 IKF Amateur North American Classic Kickboxing
Championships, which would include The IKF or any and all of their
officials, affiliated organizations, and/or their directors, officers,
employees, agents or managers, fellow participants, trainers, TKO Sports Group
Inc., Wyndham Palace Resort and Spa or any and all of their affiliated
organizations, and/or their directors, officers, employees, agents or managers
and (b) any or all manufacturers, distributors, wholesalers, suppliers and/or
retailers of the facilities and equipment I will use in connection with any and
all activities conducted and/or sponsored by The IKF and TKO Sports Group Inc.,
Wyndham Palace Resort and Spa and any and all of these companies, federations
or organizations associates, officials, employees and staff (collectively
referred to as the "suppliers"), The Suppliers and shall
collectively be referred to as "Releasees" for damages,
injury, emotional distress claims, bodily injury claims, and punitive damages,
whether known or unknown, foreseen or not, due to or resulting from the acts,
conduct, negligence, or misfeasance of, or omissions or failures to act by, the
Releasees, or any of them. (a) being accepted as a competitor of the 2004
IKF Amateur North American Classic Kickboxing Championships, (b) being
entitled to participate in activities conducted and sponsored by the IKF and
TKO Sports Group Inc., Wyndham Palace Resort and Spa and (c) being permitted to
use facilities and equipment, whether owned or leased by The IKF and all
associates, officials, employees, staff or by TKO Sports Group Inc., Wyndham
Palace Resort and Spa or by fellow participants and trainers/coaches. I hereby
agree that I, my heirs, distributees, guardians, successors in interest and
legal representatives (collectively referred to as "Releasor") will
not make a claim or file an action or suit against, sue, or attach the property
of (a) the 2004 IKF Amateur North American Classic Kickboxing Championships,
which would include The IKF or any and all of their officials, affiliated
organizations, and/or their directors, officers, employees, agents or managers,
fellow participants, trainers, and (b) any or all manufacturers, distributors,
wholesalers, suppliers and/or retailers of the facilities and equipment I will
use in connection with any and all activities conducted and/or sponsored by The
IKF, TKO Sports Group Inc., Wyndham Palace Resort and Spa and any and all of
these companies, federations or organizations associates, officials, employees
and staff (collectively referred to as the "suppliers") and TKO Sports
Group Inc., Wyndham Palace Resort and Spa and any and all of these companies,
federations or organizations associates, officials, employees, staff. The
Suppliers and shall collectively be referred to as "Releasees), for
damages, injury, emotional distress claims, bodily injury claims, and punitive
damages, whether known or unknown, foreseen or not, due to or resulting from the
acts, conduct, negligence, or misfeasance of, or omissions or failures to act
by, the Releasees, or any of them.
- Application of State Law: In further
consideration of (a) being accepted as a competitor in the 2004 IKF Amateur
North American Classic Kickboxing Championships, (b) being entitled to
participate in activities conducted and sponsored by The IKF, TKO Sports Group
Inc., Wyndham Palace Resort and Spa and any and all of these companies,
federations or organizations associates, officials, employees and staff, and (c)
being permitted to use facilities and equipment, whether owned or leased by The
IKF, TKO Sports Group Inc., Wyndham Palace Resort and Spa and any and all of
these companies, federations or organizations associates, officials, employees
and staff, I hereby agree that this Release from Liability shall be interpreted
under and construed in accordance with the Florida State law only, without the
benefit of and fully disregarding all Florida State conflicts of laws
provisions, so that any and all disputes, contentions, disagreements or
controversies arising from or related to (a) this Release from Liability, (b)
the application for acceptance into the Challenge, or (c) my participation in
any and all activities conducted or sponsored by The IKF, TKO Sports Group Inc.,
Wyndham Palace Resort and Spa and any and all of these companies, federations or
organizations associates, officials, employees and staff and Shall be
interpreted under and in accordance with only the Florida State law regardless
of my domicile or residency; and that the only court in which an action or suit
may be brought in connection with the foregoing shall be the court of original
jurisdiction of the State of Florida. Further, I waive any right I may have to
assert the doctrine of forum non conveniens or similar doctrine or to object to
venue with respect to any proceeding brought in accordance with this Release,
and I stipulate that the Florida courts shall have in personam jurisdiction
and venue over me for the purpose of litigation any dispute, controversy, or
proceeding arising out of or related to this Release, The IKF, TKO Sports Group
Inc., Wyndham Palace Resort and Spa and any and all of these companies,
federations or organizations associates, officials, employees and staff.
- Health Advisory and Condition. I hereby
acknowledge and understand that participating in this event involves extremely
strenuous physical activity and heavy physical contact, and that I have been
advised to consult a physician before commencing and undertaking such activity.
I hereby represent that, to the best of my knowledge, I am in good physical
health and condition, sufficient to undertake this dangerous and hazardous
competition.
- Knowing and Voluntary Execution. I hereby declare
that I have read this Release from Liability, and that I fully understand the
meaning and importance of its contents. I acknowledge that this Release is a
binding contract among The IKF, TKO Sports Group Inc., Wyndham Palace Resort and
Spa and any and all of these companies, federations or organizations
associates, officials, employees, staff and myself, and that under this
contract I am releasing The IKF (International Kickboxing Federation) TKO
Sports Group Inc., Wyndham Palace Resort and Spa and any and all of these
companies, federations or organizations associates, officials, employees and
staff from all liability for claims I may have against them. I further declare
and represent that I am at least 18 years of age, that I have full legal
capacity to be bound by this contract, and that I am signing this contract of my
own free will and accord.
Executed at _________________AM/PM, on this
_________day of ____________________ , in the year 2004.
Applicant/Releasor:
Signature:
_________________________________________ Print Name:
_____________________________