2010 Mid America Karate Tournament a Cancer Benefit for Spencer Determan
Presented by Pam Johansen affiliated with USKK Federation and USKK&W
March 20 2010
Holton High School, 901 New York, Holton, Kansas
(From Highway 75, Right (East) on 4th Street also called 116, Left (North) on New York to High School about 5 blocks.
Time Schedule
9:00 Tournament Check-in
10:00 Weapons Kata
Fees
$25.00 for all events Pre-registered by 3/10/10
$35.00 Day of event
In consideration of your acceptance of my entry, I do hereby for myself
my heirs, executors and administrators, waive, release and forever
discharge any and all rights and claims for damages for which I have or
may accrue to me, against Mid America Karate Academy, Mid America
Karate Open Tournament, and all members of the tournament, or their
respective officers, and against any competitor for any and all damages
which may be sustained by me in connection with any association with
or entry in the above athletic meet, or which may arise out of traveling
to, participating in, and returning form such athletic meet.
_____________________________________________________Date____________
Signature of Contestant or Parent/Guardian
Please fill out form online, print then sign and mail to: Mid America Karate Academy-24175 Bison Road-Paxico, KS 66526
