20120188 GOLDEN STATE WUSHU CHAMPIONSHIP RREGISTRATIONEGISTRATION FORM

For easiest registration and payment go to www.GoWushu.com. (No PROCESSING FEE for online registration). Registration closes on 5/28/2018

*You must fill out information clearly. It is essential to supply an active email account. Your lot number will be drawn using your supplied email address. *Name of Participant ______*M/F ____*Date of Birth ______*Nationality ______Passport #______(only INT)

Street ______Apt # ______, City ______State/ Zip ______Country ______

*Email (Print) ______*Phone ______Marti art school or Group______

All-Around Championship: Please indicate registration by writing “KFAR” for KungFu All-Around and/or Tai-Chi (Taiji) All-Around “TCAR” and/or “TDTT” for Traditional Team Trials and/or “HQTT” for Health Qigong National Team Trials in boxes below.

Fee: $60 Registration fee, and $20 for each event. All-Around Championship fee is $30. Traditional Wushu Team Trials and Health Qigong Team Trials fee is $30. Refer to “Form 1” and enter event codes below. Golden State Events Code:

Registration fee $60 + ______( cost of events) 20/each event Must be received by 5/28/2018 Total $______KFAR ______TDTT______TCAR______HQTT______Grand Total $______

Pay by Fax (408) 973 -8200

Visa, or MasterCard only, $5 more for each credit card payment. Payment by mail or fax will be accepted. Make advance payment by money Card Holder Name (First Name ______and Last Name ______) order, or check payable to: Billing Address: ______, city______Zip code: ______National Tai Chi Wellness Foundation Cardholder Phone # ______Address: 1292 Anvilwood Court Sunnyvale CA 94089 Card #: ______Card SSC ____ Expiration (Month/Year) ____/_____ $30 fee for return checks; $5 processing fee for Total Enclosed (+$5 ) = $ ______using fax form pay by credit cards. NO REFUNDS Authorized Signature of Cardholder: ______

Status: All Participants - *Athletes *Team Managers *Coaches *Masters *Observers *Spectators *Volunteer *Judges…

I______knowingly and without duress, do voluntarily submit my entry into The USAWKF National Wushu Team Trials and Golden State International Wushu Championships. These Team Trials, Championships are hosted by the United States of America Wushu-Kungfu Federation (USAWKF), and organized by the Li’s Wushu Academy and National Tai Chi Wellness Foundation (NTCWF). Hereafter, USAWKF, Li’s Wushu, NTCWF collectively are referred to as the Organizing Committee. I hereby assume all risk of physical and mental injuries, disabilities, and losses, which may result from or in connection with my participation in the tournaments or events. I fully understand that any medical attention or treatment afforded to me by the Organizing Committee will be of the first aid type only. Acting for myself, heirs, personal representatives, and assignees, I do hereby release and forever discharge, and agree to indemnify and hold harmless the Organizing Committee, and their officers, agents, officials, judges, representatives, servants, employees, volunteers, sponsors and all other related members from all claims, actions, suits, and controversies at law or in equity by reason of any matter, cause, or thing whatsoever that I may sustain as a result of or in connection with my participation in the tournaments or events, use of the Organizations equipment and facilities including travel thereto there from, whether due to the negligence, omission, default or other action of any person or entity. I also understand that participation in the tournaments or events, especially but not limited to fighting point or full contact sparring matches, entails a great risk of injury, and I assume full responsibility for all of my actions, intentional or otherwise, during and in connection with my participation in the trials. I agree that my performance, attendance, and participation at the trials may be filmed or otherwise recorded or telecast live. I consent to the use by the Organizing Committee of my name, likeness, voice, poses, pictures, tournaments or events films, and biographical data concerning fully or in parts, in any form or language, with or without other material, throughout the world, without limitation, for television, radio, video, theatrical motion pictures, Internet, or any other medium by devices now known or hereafter devised, and I do hereby waive any compensation in regard thereof as well as any future rights to the aforementioned. I understand that the rules and regulations applicable to the USAWKF and the International Wushu Federation (IWuF) are designed, in part, for the safety and protection of participants. I agree to abide by the rules and regulations established by the IWuF, and the Organizing Committee. of which a copy may be obtained by written request via mail or facsimile. I certify that all information provided above is true and correct to the best of my knowledge and belief, and I have read and fully understand the Waiver listed above.

______Competitor Must Sign or Parent/Guardian Signature if Applicant Under 18 Date 日期 运动员必须签名（十八岁以下须有父母或监护人代为签名 ）

Registration Form for Duilian and Jiti (Group) Competition Team Name 团队 ______

Contact person Name: ______Phone 电话______Email ______WeChat ID:______*If the athletes in the Duilian event are not competing in any individual events, one competitor must pay $60 for registration fee and an additional $20 for each additional person in the group. Registration fee is waived if one competitor is also in individual events. Dui Lian Fee: ______Pay by: (name) ______Cell: ______

对练编码 Dui Lian 运动员名单 Athlete Name List 对练名称 Name of the Form Code

Jiti Total fee: ______Pay by: (name) ______Cell: ______

集体 Jiti Email: ______比赛内容／名称 音乐 Jiti 集体表演者名单 Jiti Athlete Name list Name of the Jiti (Group) Form Music Event

------, ------, ------有 集体 ------, ------, ------Yes Jiti 1 ------, ------, ------, ------, ------Code ------, ------, ------, ------, ------无 ————— ------, ------, ------No ------, ------, ------

------, ------, ------, ------, ------有 集体 Jiti 2 ------, ------, ------Yes

------, ------, ------Code ------, ------, ------

------, ------, ------无 ————— ------, ------, ------No ------, ------, ------, ------, ------, ------, ------有 集体 Jiti 3 ------, ------, ------Yes

------, ------, ------Code ------, ------, ------

------, ------, ------无 ————— ------, ------, ------No ------, ------, ------

Form 1 比赛项目编码表 Tournament Events * All “standard” forms are those established by IWuF. ** “Optional” forms are individual, self-created forms not established by IWuF 现代武术拳术 Modern Wushu Hand Forms 1045 传统双剑 Traditional Twin Straight Sword 健身⽓功 Health Qigong 1000 五步拳 5 Steps Long Fist 1046 其它传统单兵器 Other Traditional Single Short Weapon 1091 ⼋段锦 Baduanjin 1001 初级⼀路长拳 1st Road Beginning Long Fist 1047 其它传统双兵器 Other Traditional Twin Short Weapon 1092 五禽戏 Wuqinxi 1002 IWuF初级长拳 Elementary Long Fist (IWuF) * 1048 功夫扇 （单／双） Kung Fu Fan (Single/Twin) 1093 易筋经 Yijinjing 1003 其它初级长拳 Other Beginning Long Fist 传统长器械 Traditional Long Weapons 1094 六字诀 Liuzijue 1004 IWuF所有规定长拳 Standard Long Fist (IWuF 1、2、3 set)* 1049 传统少林棍 Traditional Shaolin Staff 1095 ⼤舞 Da Wu 1005 自选长拳 Optional Long Fist** 1050 传统南棍 Traditional Southern Staff 1096 马王堆导引术 Ma Wang Dui Daoyin Shu 1006 IWuF 所有规定南拳 All Standard Southern Fist IWuF* 1051 其它传统棍 Other Traditional Staff 1097 太极养⽣杖 Tai Ji Yang Sheng Zhang 1007 自选南拳 Optional Southern Fist ** 1052 传统少林枪 Traditional Shaolin Spear 1098 ⼗⼆段锦 Shi Er Duan Jin 现代武术短器械 Contemporary Wushu Short Weapons 1053 其它传统枪 Other Traditional Spear 1099 导引养⽣⼗⼆法 Dao Yin Yang Sheng Shi Er Fa 1008 IWuF初级⼑ Elementary Broad Sword (IWuF)＊ 1054 扑⼑ Pudao 对练 Duilian 1009 其他初级⼑法 Other Beginning Broad Sword 1055 关⼑（春秋⼤⼑）Traditional Kwandao 1100 武术类徒⼿对练 Wushu Barehand Duilian 1010 IWuF所有规定⼑ All Standard Broad Sword (IWuF)＊ 1056 其它传统长兵器 Other Traditional Long Weapons 1101 太极类徒⼿对练 Taiji Barehand Duilian 1011 自选⼑Optional Broadsword 传统软兵器 Traditional Soft Weapons 1102 武术类器械对练 Wushu Weapon Duilian 1012 IWuF所有规定南⼑ All Standard Southern Broad Sword (IWuF)＊ 1057 双截棍 Nunchaku 1103 太极类器械对练 Taiji Weapon Duilian 1013 自选南⼑ Optional Southern Broad Sword** 1058 三节棍 Three-section Staff 集体比赛 Group Competition 1014 初级剑 Elementary Straight Sword (IWuF)* 1059 九节鞭 9 Section Single Whip 1104 集体5步拳 Group 5 Stept Fist 1015 其它初级剑 Other Beginning Straight Sword 1060 双鞭（含⼑加鞭）Double Whip or Whip with Sword 1105 集体长拳 Group Long Fist 1016 IWuF所有规定剑 All Standard Straight Sword (IWuF)＊ 1061 其它软兵器 Other Traditional Soft Weapons 1106 集体少林功夫 Group Shaolin KungFu 1017 自选剑 Optional Straight Sword** 太极拳类 Taiji Hand Forms 1107 集体其它武术类拳法 Group Other Wushu Hand Form 现代武术长器械 Contemporary Wushu Long Weapons 1062 24式太极拳 24 Taiji Quan 1108 集体武术类拳械 Group Wushu Hand Form＋Weapon 1018 初级棍 Elementary Staff (IWuF)* 1063 42式太极拳 42 Taiji Quan 1109 集体武术短器械 Group Wushu Short Weapon Foum 1019 其他初级棍法 Other Beginning Staff 1064 32 式、40式太极32，40 Yang Taiji Quan 1110 集体武术长器械 Group WushuLong Weapon Foum 1020 IWuF所有规定棍 All Standard Staff (IWuF)＊ 1065 其它杨式太极拳 Other Yang Taiji Quan 1111 集体24式太极拳 Group 24 Taiji Quan 1021 自选棍 Optional Staff** 1066 陈⽒老架⼀路 Chen Taiji Old Form 1st Road 1112 集体42式太极拳 Group 42 Taiji Quan 1022 初级抢 Elementary Spear (IWuF)* 1067 陈⽒老架⼆路 Chen Taiji Old Form 2nd Road 1113 集体杨式太极拳 Group Yang Taiji Quan 1023 其他初级枪法 Other Beginning Spear 1068 陈⽒新架⼀、⼆路 Chen Taiji New Form 1st－2nd Road 1114 集体陈式太极拳⼀路 Group Chen Old Style Taiji 1st Form 1024 IWuF所有规定枪 All Standard Spear (IWuF)＊ 1069 混元太极 Hunyuan Taiji Quan 1115 集体陈式太极拳⼆路 Group Chen Taiji Old Style 2nd Form 1025 自选抢 Optional Spear** 1070 其它陈太极拳 Other Chen Style Taiji Quan 1116 集体陈式太极拳新架⼀路，Group Chen Taiji New Style 1st Form 1026 初级南棍 Beginning Southern tff 1071 吴式太极拳 Wu Taiji Quan 1117 集体混元太极拳 Group Hun Yuan Taiji Quan 1027 IWuF所有规定南棍 All Standard Southern Staff (IWuF)＊ 1072 吴式太极拳竞赛套路 WuTaiji Quan Competition Form 1118 集体赵堡太极拳 Group Zhaobao Taiji Quan 1028 自选南棍 Optional Southern Staff** 1073 孙式太极拳 Sun Taiji Quan 1119 集体东岳太极拳 Group DongYue Quan 传统拳法 Traditional Hand Forms 1074 孙式太极拳竞赛套路 Sun Taiji Quan Competition Form 1120 集体武当太极拳 Group Other Wushu Hand Form 1029 传统少林拳 Traditional Shao Lin Hand Forms 1075 武式太极拳 Wu Hao Taiji Quan 1121 集体其它太极拳 Group Other Tai Chi Hand Form 1030 其它少林拳 Other Shaolin Fist 1076 武式太极拳竞赛套路 Wuhao Taiji Quan Competition Form 1122 集体32式太极剑 Group 32 Taiji Sword 1031 传统南拳 Traditional Southern Fist 1077 赵堡太极拳 Zhaobao Taiji Quan 1123 集体42式太极剑 Group 42 Taiji Sword 1032 形意、⼋卦、⼋极、翻⼦ Xinyi, Bagua, Baji, Fanzi 1078 东岳太极拳 Dongyue Taiji Quan 1124 集体杨式太极剑 Group Yang Taiji Sword 1033 地躺、披挂、通臂 Ditang, Pigua, Tongbei 1079 武当太极拳 Wudang Taiji Quan 1125 集体陈式太极剑 Group Chen Sword 1034 查拳、华拳、炮拳 Chaquan, Huaquan,Paoquan 1080 其他太极拳 Other Taiji Quan 1126 集体武当太极剑 Group Wudang Tai Chi Sword 1035 象形拳 XiangxingQuan (Animal Styles) 太极器械类 Taiji Weapons 1127 集体太极扇 Group Taiji Fan 1036 武当、峨嵋拳法 Wudang E-mei Hand Forms 1081 杨式太极⼑ Yang Taiji Broad Sword 1128 集体其它太极器械 Group Other Tai Chi Weapon 1037 其它传统拳术 Other Traditional Hand Forms 1082 陈式太极⼑ Chen Taiji Broad Sword 1129 集体⼋段锦 Group Baduanjin 传统短器械 Traditional Short Weapons 1083 其它太极⼑ Other Taiji Broad Sword 1130 集体五禽戏 Group Wuqinxi 1038 传统少林⼑ Traditiona Shaolin Broadsword 1084 杨式太极剑 Yang Taiji Straight Sword 1131 集体易筋经 Group Yijinjing 1039 传统南刀 Traditional Southern Broadsword 1085 陈式太极剑 Chen Taiji Straight Sword 1132 集体六字诀 Group Liuzijue 1040 其它传统单⼑ Other Traditional Single Broadsword 1086 32式太极剑 32Taiji Straight Sword 1133 集体⼤舞 Group Da Wu 1041 传统少林双⼑ Traditional Shaolin Twin Broadsword 1087 42式太极剑 42 Taiji Straight Sword 1134 集体马王堆导引术 Group Ma Wang Dui Daoyin Shu 1042 其它传统双⼑ Traditional Twin Broadsword 1088 其它太极剑 Other Taiji Straight Sword 1135 集体太极养⽣杖 Group Tai Ji Yang Sheng Zhang 1043 少林单剑 Shaolin Traditional Single Straight Sword 1089 其它太极短兵器 Other Taiji Shirt Weapons 1136 集体⼗⼆段锦 Group Shi Er Duan Jin 1044 其他传统单剑 Other Traditional Straight Sword 1090 其他太极长兵器 Other Taiji Long Weapons 1137 集体导引养⽣⼗⼆法 Group Dao Yin Yang Sheng Shi Er Fa