Attention all Team Lloyd Irvin BJJ White Belt Competitors Ages 14 & Up!!!

Fill out this registration form, print it out and turn it in by Friday at 8pm. Registration if FREE to those who register by Thursday at 3pm.

Team Lloyd Irvin Brazilian Jiu- Jitsu Championship Tourney 2008
INDIVIDUAL REGISTRATION FORM

Competitor Information

LAST NAME:
FIRST NAME:
ADDRESS:
CITY:
STATE:
ZIP Code/Postal Code:
COUNTRY:
PHONE:
EMAIL:

 

GENDER: (circle one)             MALE          FEMALE

 

EMERGENCY CONTACT

NAME
PHONE

 

 

I _______________________ understand that by entering this competition I will be competing at my own risk. I understand that Jiu -Jitsu is a potentially dangerous and / or fatal sport and agree that I will hold blameless The Lloyd Irvin Mix Martial Arts Academy and each of their agents and representatives from any liability in case of my injury or death at this tournament or as a result thereof. I also state I am in good physical condition and know of no reason why I cannot participate in this tournament. By signing this release form each and every competitor acknowledges that his or her performance might be video taped for future DVD release by LIMMA. LIMMA tournament has the right to release any images, footages or videos of any or every competitor.

 

Signature_______________________________ Date ___________

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