Register for an event/ Sponsor World Championship Grappling

FULL NAME

EMAIL ADDRESS

PAY PAL CONFIRMATION #

BEST PHONE NUMBER

ADDRESS

TOWN/ CITY

STATE

ZIP CODE

GENDER

MALE
FEMALE

BIRTHDAY (00/00/0000)

DIVISION (CHECK ALL THAT APPLY)

WHITE
BLUE
PURPLE/ BROWN/ BLACK
BEGINNER (NOGI)
INTERMEDIATE (NOGI)
ADVANCED (NOGI)
I PREFER GI
I PREFER NOGI

AGE

WEIGHT

ACADEMY NAME

AFFLIATION

INSTRUCTOR/COACH

EMERGENCY CONTACT

EMERGENCY CONTACT PHONE #

World Championship Grappling (Promoter), Submission Combat Series (Promoter) without limitation, their respective officials, employees, fighters, volunteers and representatives, are not liable for injuries, expenses, claims, or liabilities resulting from or related to participating and/or attending events promoted by World Championship Grappling and Submission Combat Series, including, but not limited to events, shows and/or tournaments. This agreement is a revocable license subject to termination with denial of participation and/or admission and subject to revocation and ejection at the promoter’s discretion, without compensation, should the participant holder act in a disorderly manner or violate the promoter’s rules and regulations. The participant and/or ticket holder grants World Championship Grappling and Submission Combat Series irrevocable permission to use his or her voice, image, or likeness as a part of any live or recorded photograph, video display, broadcast or other transmission, reproduction, or depiction in any media now or hereafter existing of all or any part of the event or related events to which this participant and/or ticket/registration/fee admits the holder. Event rules, date, and time is subject to change without notice. We reserve the right to group competitors as close to registration as possible and may adjust divisions to do so. ALL PURCHASES ARE FINAL. NO REFUNDS OR EXCHANGES! (UNLESS DETERMINED APPROPRIATE BY WORLD CHAMPIONSHIP GRAPPLING and SUBMISSION COMBAT SERIES)

I ACCEPT (MUST ACCEPT TERMS TO COMPLETE REGISTRATION)