ANNUAL PLUM BLOSSOM INTERNATIONAL FEDERATION CHAMPIONSHIPS Saturday, September 12th, 2009 Kezar Pavilion 755 Stanyan St (at Waller St) San Francisco CA 94117 Please print neatly: First Name______Last name______Birth Date _____/_____/______Home Address ______City______State ______Zip______Phone ( _ _ _ ) _ _ _ - _ _ _ _ Age______Gender______Weight______Current Choy Li Fut Rank ______Tai Chi Rank ______Choy Li Fut Class (circle one): Beg Int Adv Ins Sr Ins Class (circle one): Beg Int Adv Ins Sr Ins Martial Art School ______School Address ______City______State ______Zip______Phone ( _ _ _ ) _ _ _ - _ _ _ _ Head Instructor ______Liabilty Waiver: I, the undersigned/or the competitor, by submitting this application understand that I am consenting to release this event promoter The Doc-Fai Wong Martial Arts Center, Kezar Pavilion and all other persons associated with this event from any liability arising out of injury, damages, or losses that I may incur as a result of my attendance or my participation in this event, and I also hereby waive all claims to any injuries sustained from such an event. I fully understand that a competitor who executes a fouling technique which is deemed malicious with the intent of causing injury above and beyond what is expected in competition, may be subject to bearing the medical as well as related recovery and recuperation expenses of a competitor who is injured as a result of a fouling technique. I clearly understand that the fighting aspects of this sport and competition involve bodily contact and that no contact is allowed to the head and groin area. I hereby certify to the best of my abilities that I am mentally and physically fit to participate and compete in this event, and I also understand that any medical treatment will be of the First Aid type only. Furthermore, I hereby permanently waive any compensation whatsoever for the use of pictures, videos, media coverage, etc. utilized by those associated with this event which may be used for profit making purposes. Signature of Applicant Participants/ OR Parent/Legal Guardian if under the age of 18 ______Date ______BEGINNER HAND FORMS Tai Chi Forms (1 min 30 secs) Advanced (Non-Ins) Form 1/Siu Jin Kuen [ ] T40 8 Step (Beg) [ ] A90 Hand Form All Ages [ ] K1 Ages 4-6 (Beg) [ ] T41 16 Step (Beg) [ ] A91 Short Weapon Form All Ages [ ] K2 Ages 7-11 (Beg) [ ] T42 24 Form (Beg) [ ] A92 Long Weapon Form All Ages [ ] K3 Ages 12-16 (Beg) [ ] T43 Open Form (Int) [ ] A93 2 Person Hand/Weapon Form All Ages [ ] K4 Ages 17-39 (Beg) [ ] T44 32 Sword (Int) [ ] A94 2 Min. Cont. Women Form 2/Siu Pau Kuen [ ] T45 Open Weapon (Int) [ ] A95 2 Min. Cont. Sparring Men [ ] K5 Ages 4-6 (Beg) [ ] T46 Open Form (Adv) [ ] A96 Push Hands Women [ ] K6 Ages 7-11 (Beg) [ ] T47 Sword Form (Adv) [ ] A97 Push Hands Men [ ] K7 Ages 12-16 (Beg) [ ] T48 Open Weapon From (Adv) (Children must compete in their own age [ ] K8 Ages 17-39 (Beg) [ ] T49 Open Form (Instructor) divisions for sparring and push hands events.) [ ] T50 Sword Form (Instructor) [ ] K9 Ages 40 & Up Form 1 or 2 (Beg) Instructors Kung Fu [ ] T51 Open Weapon From (Instructor) [ ] B100 Hand Form Open Weapon Form [ ] T52 Open Form (Sr. Instructor) [ ] B101 Short Weapon Form [ ] K10 16 & Below (Beg) [ ] T53 Sword Form (Sr. Instructor) [ ] B102 Long Weapon Form [ ] K11 17& Up(Beg) [ ] T54 Open Weapon From (Sr. Instructor) 5 Wheel Fist [ ] B103 2 Person Hand/Weapon Form [ ] K12 Ages 7-11 (Beg) Stationary Push Hands [ ] B104 2 Min. Cont. Sparring Women [ ] K13 Ages 12-16 (Beg) [ ] P60 Ages 4-6 Boys & Girls [ ] B105 2 Min. Cont. Sparring Men [ ] K14 Ages 17-39 (Beg) [ ] P61 Ages 7-9 Boys & Girls [ ] B106 Push Hands Women [ ] P62 Ages 10-12 Boys [ ] B107 Push Hands Men Open Hand Form [ ] P63 Ages 10-12 Girls Sr. Instructors Kung Fu [ ] K15 Age 16 & Below (Beg) [ ] P64 Ages 13-16 Boys [ ] C110 Hands Form [ ] K16 Age 17 & Up (Beg) [ ] P65 Ages 13-16 Girls [ ] C111 Short Weapon Form INTERMEDIATE HAND FORMS [ ] P66 Ages 17 & Up Men (Beg) [ ] C112 Long Weapon Form Form 1/Siu Jin Kuen or Form 2/Siu Pau Kuen [ ] P67 Ages 17 & Up Women (Beg) [ ] C113 2 Person Hand/Weapon Form [ ] K17 Ages 4-6 (Int) [ ] P68 Ages 17 & Up Men (Int) [ ] C114 2 Min. Cont. Sparring Men [ ] K18 Ages 7-11 (Int) [ ] P69 Ages 17 & Up Women (Int) [ ] C115 Push Hands Men 5 Wheel Fist 2 Min Continuous Sparring [ ] K19 Ages 7-11 (Int) [ ] S70 Ages 7-9 Boys & Girls PRE-REGISTRATION FEES: [ ] K20 Ages 12-16 (Int) [ ] S71 Ages 10-12 Boys First Event $30 = $ ______[ ] K21 Ages 17-39 (Int) [ ] S72 Ages 10-12 Girls Each Additional Event $15 ea x __ = $ ______[ ] K22 Ages 40 & Up (Int) [ ] S73 Ages 13-16 Boys [ ] S74 Ages 13-16 Girls LATE REGISTRATION/AT THE DOOR FEES: Wall Bag Set (After Aug 31, 2009) [ ] S75 Ages 17 & Up Men (Beg) [ ] K23 Ages 7-16 (Int) First Event $45 = $ ______[ ] S76 Ages 17 & Up Women (Beg) [ ] K24 Ages 17-39 (Int) Each Additional Event $15 ea x __ = $ ______[ ] K25 Ages 40 & Up (Int) [ ] S77 Ages 17 & Up Men (Int) [ ] S78 Ages 17 & Up Women (Int) SPECTATOR FEES: Siu Sup Ji Under 3 FREE [ ] K26 Ages 7-16 (Int) Short Weapon Sparring Ages 4-11 $ 5 ea x __ = $ ______[ ] K27 Ages 17-39 (Int) [ ] W80 Ages 4-6 Boys & Girls Ages 12 & Up $10 ea x __ = $ ______[ ] K28 Ages 40 & Up (Int) [ ] W81 Ages 7-9 Boys & Girls [ ] W82 Ages 10-12 Boys & Girls Banquet* $25 ea x __ = $ ______Open Hand Form [ ] W83 Ages 13-16 Boys & Girls [ ] K29 16 & Below (Int) TOTAL** $ ______[ ] W84 Ages 17 & Up Men (Beg) [ ] K30 17 & Up (Int) [ ] W85 Ages 17 & Up Women (Beg) Please make checks payable to: Open Weapon Form [ ] W86 Ages 17 & Up Men (Int) “Doc-Fai Wong” [ ] K31 16 & Below (Int) [ ] W87 Ages 17 & Up Women (Int) Mail entries to: [ ] K32 17 & Up (Int) Doc-Fai Wong Martial Arts Center 2 Person Hand or Weapon Form For all 2 Min. Cont. Sparring, Weapon Sparring & 925 Taraval St Push Hands divisions, competitors will be divided by [ ] K33 16 & Below 2 Person Hand Form (Int) San Francisco, CA. 94116 gender, weight and rank at the time of competition. [ ] K34 17 & Up 2 Person Hand Form (Int) 2 Min. Cont. Sparring equipment is mandatory *Banquet seats are limited to the first 400 registrants. [ ] K35 16 & Below 2 Person Weapon Form (Int) (provided by competitor). Pads include head, chest, **No refunds will be provided. [ ] K36 17 & Up 2 Person Weapon Form (Int) gloves, shin, foot, hard cup and protective mouth piece. For questions regarding the tournament, please contact (415) 665-2488 or visit www.plumblossom.net