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