Individual Registration Form

W.O.M.A.A. WORLD MARTIAL ARTS GAMES XVII

INDIVIDUAL PRE-REGISTRATION FORM
Pre-register for individual events, King/Queen of the Ring, and World Title Belt by June 21, 2017 for the best value. THERE WILL BE NO ONLINE REGISTRATION AVAILABLE AFTER JUNE 21, 2017. If you miss the online pre-registration you can register at the venue on the day of the event (prices will increase). Please be sure to input the age that the competitor will be on the day of the event. IMPORTANT: Please take care in filling out this entry form. It must be accurate and complete or it may cause the competitor to miss his/her competition or possibly face disqualification. NO refunds will be issued for clerical errors or missed divisions. NO EXCEPTIONS!
Full Name:*
Age:*
Sex: (M or F)*
Address (required)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth:*
Primary Phone:*
Secondary Phone:
Height:*
Weight:*
Belt Color:*
Rank:
Style:*
Category:*
School Name:*
Coach/Instructors Name:*
E-mail*
Individual Registration Entry

Please insert the correct letter/number code for each individual entry in the boxes below by following the 2017 Divisions link.
2017 Divisions List
1st Entry*
2nd Entry
3rd Entry
4th Entry
5th Entry
6th Entry
7th Entry
8th Entry
9th Entry
10th Entry
Individual Entry Payment
Individual Registration Entry Fees:
Registration Fee before June 21, 2017
First Individual Entry = €45
Each Added Division = €15

Days of Event Registration
First Individual Entry = €50
Each Added Division = €20

World Title Belt Entry = €40

Note: No photography or videography is allowed on competition floor. No spectators are allowed on competition floor (ONLY coaches, officials, and competitors). Entering floor will result in your competitors disqualification from the division. All wristbands (competitors, coaches, spectators, etc.) must be worn on the wrist or they will be denied entry: NO EXCEPTIONS. Anyone losing a wristband will be required to pay a new entry fee.

Online Payment Method: Paypal (Strictly no checks will be accepted)
For team events please use the TEAM REGISTRATION FORM. For ring sports please use RING SPORTS REGISTRATION FORM. For coach registration please use the COACH REGISTRATION FORM.

For competitors registering in an individual event (ie: forms, weapons, self defense, fighting, etc.) it is MANDATORY that you 'check' "1st Entry Fee". If you are registering for more than one (1) event 'check' "1st Entry Fee" as well as "Each Additional Entries" and select the quantity of additional events. *A 4.9% convenience fee has been added onto the cost.*

1st Entry Fee€47.21

Each Additional Entries€15.75

Number of Additional Individual Entries

World Title Belt Entry€41.96

Total €0.00

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

LIABILITY WAIVER: I, the undersigned, do hereby waive any and all claims against any and all persons and groups associated with the World Organization of Martial Arts Athletes, the WOMAA World Martial Games XVII and it’s representatives. I agree to indemnify and hold harmless, all persons and groups, including W.O.M.A.A. Int’l and WOMAA Ireland and it’s representatives, the City West Hotel/Conference Ctr it’s representatives, and anyone else involved with this tournament for any injuries or damages sustained by me in connection with my participation in this tournament, whether accidental or intentional. I understand that I am participating in a sport which usually has body contact. I assume full responsibility for all of my actions or injuries during and connected with these events. I also agree that my attendance and/or performance at these tournaments may be photographed, filmed or taped and used by the promoters and I waive any compensation, thereof. I attest and verify that I am physically and mentally fit and that I have been sufficiently trained to compete in this event. I consent to and am aware that the only offered medical treatment on site will be First - Aid. I further agree that I am solely responsible for any extended medical services and costs and therefore hold harmless all persons/groups involved in the event of my injury.

Special Note: Although WOMAA prides itself on having people attending all categories, they cannot be responsible for empty categories/NO shows, or fights not going ahead due to injury or any other reason. Obviously we will try and accommodate you by arranging either a single exhibition match or by allowing you to enter another style at registration. But absolutely NO REFUNDS will be given for missed divisions, injuries, etc.

IN ORDER TO PARTICIPATE, THIS ELECTRONIC SIGNATURE IS VALID UNTIL THE DAY OF THE EVENT WHERE YOU WILL BE REQUIRED TO SIGN A HARD COPY OF THE LIABILITY WAIVER AND TERMS.
Agreements:*

I have read and agree to the W.O.M.A.A. rules and agreement. I understand that there will be NO REFUNDS. I understand that W.O.M.A.A. is not responsible for clerical errors or missed divisions.
Competitor Signature*
Parent/Guardian's Signature (if under 18 years of age)*
A signature is required in one of the fields. The field without a signature place 'N/A'. This form will not be valid if both fields have 'N/A'.
Date of Signature:*

MonthDayYear
Enter the message as it's shown*
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W.O.M.A.A. WORLD MARTIAL ARTS GAMES XVII

Individual Registration Entry

Individual Entry Payment