OmeiKungͲFuCenter USAWKFNationalTraditionalWushuTeamTrials DĂƌĐŚϯϬ͕ϮϬϭϵ

Last Name: ______First Name:______

DOB: ______Gender: ___ Male ___ Female

Street: ______

City: ______State: ______Zip Code: ______

E-mail: ______

MailintheregistrationpackagepostͲstampedbytheregistrationdeadline. RegularRegistrationFee:$ϵϬ(befŽƌĞMarchϮϯ,20ϭϵͿŝŶĐůƵĚĞƐƵƉƚŽϯĞǀĞŶƚƐ͘ ĚĚŝƚŝŽŶĂůΨϮϬĨŽƌĞĂĐŚĂĚĚŝƚŝŽŶĂůĞǀĞŶƚŽǀĞƌϯ͘ MakepaymentĂŶĚƌĞŐŝƐƚƌĂƚŝŽŶto: OmeiWushuKungfuCenter 2929ͲDEskridgeRoad Fairfax,VA22031 6HQGFRPSOHWHGUHJLVWUDWLRQIRUPWRRPHLZXVKX#\DKRRFRP Traditional Hand Form Traditional Short Weapon

__ 400(Traditional Shao Lin Hand Form) __ 500(Traditional Shaolin Broadsword) __ 401(Other Shaolin Hand Form) __ 501(E-mei, Wudang Broadsword) __ 402(Traditional E-mei Hand Form) __ 502(Traditional Southern Broadsword) __ 403(Chaquan,Huaquan,Paoquan) __ 503(Other Traditional Single Broadsword) __ 404(Xinyi, Bagua, Baji, Fanzi Hand Form) __ 504(Traditional Shaolin Twin Broadsword) __ 405(Ditang, Pigua, Tongbei Hand Form) __ 505(Wing Chun Broadwords) __ 406(Xiangxing Quan (Animal Styles) __ 506(Traditional Twin Broadsword) __ 407(Wing Chun Quan) __ 507(Shaolin Single Straight Sword) __ 408(Other Northern Style Hand Form) __ 508(E-mei, Wudang Straight Sword) __ 409(Other Southern Style Hand Form) __ 509(Other Traditional Straight Sword) __ 410( Other Traditional Hand Form) __ 510(Traditional Twin Straight Sword) __ 511(Other Traditional Single Short Weapon) __ 512(Other Traditional Twin Short Weapon) __ 513( Fan (Single / Twin)) __ 514(Dagger (Single/Twin)) Traditional Long Weapon Traditional Soft Weapon

__ 600(Traditional Shaolin Staff) __ 700(Shaolin Nunchuck) __ 601(E-mei, Wudang Staff) __ 701(Other Nunchuck) __ 602(Traditional Southern Staff) __ 702(Three-section Staff) __ 603(Other Traditional Staff) __ 703(9 Section Single Whip ) __ 604(Shaolin Spear) __ 704(Double Whip or Whip with Sword) __ 605(E-mei, Wudang Spear) __ 705(Other Traditional Soft Weapon) __ 606(Other Traditional Spear) __ 607(Pudao) __ 608(Traditional Kwandao) __ 609(Other Traditional Long Weapon)

Taiji Hand Forms Taiji Weapon

__ 800(24 Taiji Quan ) __ 900(Yang Taiji Broad Sword) __ 801(42 Taiji Quan ) __ 901(Chen Taiji Broad Sword) __ 802(32, 40 Yang Taiji Quan) __ 902(Other Taiji Broad Sword) __ 803(Other Yang Taiji Quan) __ 903(Yang Taiji Straight Sword) __ 804(Chen Taiji Old Form 1st Road) __ 904(Chen Taiji Straight Sword) __ 805(Chen Taiji Old Form 2nd Road) __ 905( 32 Taiji Straight Sword) __ 806(Chen Taiji New Form 1st㸫2nd Road) __ 906(42 Taiji Straight Sword) __ 807(Hunyuan Taiji Quan) __ 907(Other Taiji Straight Sword) __ 808(Other Chen Style Taiji Quan) __ 908(Other Taiji Short Weapons ) __ 809(Wu Taiji Quan) __ 909(Other Taiji Long Weapons ) __ 810(WuTaiji Quan Competition Form) __ 811(Sun Taiji Quan) __ 812(Sun Taiji Quan Competition Form) __ 813(Wu Hao Taiji Quan) __ 814(Wuhao Taiji Quan Competition Form) __ 815(Zhaobao Taiji Quan) __ 816(Dongyue Taiji Quan) __ 817(Wudang Taiji Quan) __ 818(Other Taiji Quan) Health

__ 1000(Health Qigong Baduanjin) __ 1005(Health Qigong Ma Wang Dui Daoyin Shu) __ 1001(Health Qigong Wuqinxi) __ 1006(Health Qigong Shi Er Duan Jin) __ 1002(Health Qigong Yijinjing) __ 1007( Yin Yang Sheng Shi Er Fa) __ 1003(Health Qigong Liuzijue) __ 1008(Tai Ji Yang Sheng Zhang )

__ 1004(Health Qigong Da Wu)

Liability Waiver

I,______,knowinglyandwithoutduress,dovoluntarilysubmitmyentryintothe USAWKFNationalWushuTeamTrials.TheUSAWKFNationalWushuTeamTrialsissanctionedbytheUnited States of America WushuͲKungfu Federation (USAWKF) and organized by the Omei Wushu Kungfu Center. I hereby assume all risk of physical and mental injuries, disabilities, and losses, which may result from or in connectionwithmyparticipationinthetournamentsorevents.Ifullyunderstandthatanymedicalattentionor treatmentaffordedtomebytheOmeiWushuKungͲFuCenterwillbeofthefirstaidtypeonly.Actingformyself, heirs,personalrepresentatives,andassignees,Idoherebyreleaseandforeverdischarge,andagreetoindemnify andholdharmlesstheOmeiWushuKungͲFuCenter,andtheirofficers,agents,officials,judges,representatives, servants, employees, volunteers, sponsors and all otherrelated members from all claims,actions, suits, and controversiesatlaworinequitybyreasonofanymatter,cause,orthingwhatsoeverthatImaysustainasaresult oforinconnectionwithmyparticipationinthetournamentsorevents,useoftheOrganizationsequipmentand facilitiesincludingtraveltheretotherefrom,whetherduetothenegligence,omission,defaultorotheractionof anypersonorentity.Ialsounderstandthatparticipationinthetournamentsorevents,especiallybutnotlimited tofightingpointorfullcontactsparringmatches,entailsagreatriskofinjury,andIassumefullresponsibilityfor allofmyactions,intentionalorotherwise,duringandinconnectionwithmyparticipationinthetrials.Iagree thatmyperformance,attendance,andparticipationatthetrialsmaybefilmedorotherwiserecordedortelecast live. I consent to the use by the Omei Wushu KungͲFu Center of my name, likeness, voice, poses, pictures, tournamentsoreventsfilms,andbiographicaldataconcerningfullyorinparts,inanyformorlanguage,withor withoutothermaterial,throughouttheworld,withoutlimitation,fortelevision,radio,video,theatricalmotion pictures,Internet,oranyothermediumbydevicesnowknownorhereafterdevised,andIdoherebywaiveany compensationinregardthereofaswellasanyfuturerightstotheaforementioned.Iunderstandthattherules andregulationsapplicabletotheUSAWKFandtheInternationalWushuFederation(IWuF)aredesigned,inpart, forthesafetyandprotectionofparticipants.IagreetoabidebytherulesandregulationsestablishedbytheIWuF, andtheOmeiWushuKungͲFuCenter.ofwhichacopymaybeobtainedbywrittenrequestviamailorfacsimile. Icertifythatallinformationprovidedaboveistrueandcorrecttothebestofmyknowledgeandbelief,andIhave readandfullyunderstandtheWaiverlistedabove.

Ifunder18,mustbesignedbyparentorlegalguardian.

Signature:______

Date:______