BE FIRST CHAMPIONSHIPS #7 - Submission Wrestling, Kickboxing, Pankration AND Amateur Boxing Tournament !

Saturday June 9th, 2012 at PISE - Pacific Institute for Sports Excellence

Registration Form

Participant Information
Name:
Phone #:
E-mail:
Current Address:
City:
Province:	British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Newfoundland Nova Scotia Prince Edward Island Yukon Northwest Territories Nunavut
Postal Code:
Training Academy Information
School Name:
Instructor Name(s):
School Phone #:
School E-mail:
CCSINC requires you to give as much detail as possible on your registration form. We will be doing our best to match opponents as fairly as possible, especially in the youth divisions!!
Age:
Exact Weight (in lbs):
Belt Ranking :
Emergency Contact
Name:
Phone Number:
ANY minors participating in this tournament need parental approval with contact information (parents will be contacted):
Parent Name:
Parent Phone#:
Medical #:

Division Information

Pre-Registration: $56.00 for the 1st division, $11.20 for each additional division - before May 12th, 2012.
Registration: After Deadline of May 12th - $67.20 for the 1st division/ $16.80 for each additional division.
Late Registrtaion: Day of June 9th (Registration in person only): $78.40 1st division / $16.80 additional division. Only accepted by 9AM !

Please select your appropriate division(s):

Gender:	Male Female
Event:	Gi-Submission Wrestling NO-GI Submission Wrestling Kickboxing Pankration Boxing
Youth and Kids Division	8-9 years old 10-11 years old 12 to 13 years old 14 to 15 years old 16 to 17years old
Adult Division	Mens Weight Divisions Womens Weight Divisions 145 and under 160 and under 175 and under 190 and under 191 and over 135 and under 155 and under 175 and under 176 and over
Open Weight Class? (Adults Only)	Gi Submission Wrestling NO-GI Submission Wrestling Kickboxing
Experience:	NOVICE: UNDER 1 YEAR OF TRAINING. White/Yellow/Orange Belt.       INTERMEDIATE : Aprox 2 YRS OF TRAINING. Green/Blue/Purple Belt. ADVANCED : 3 OR MORE YEARS OF TRAINING / OR IF YOU HAVE HAD A FIGHT IN ANY ORGANIZED Amateur or Professional EVENT.Red/Brown/Black Belt.

I will be paying by:

Credit Card by telephone (you will be contacted by June 7th when your division has been confirmed) Mail or in person

 

I have read and understand the terms and conditions of this registration form.

Verification Code: