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2021 United States International Kuo Shu () Championship Tournament Registration Form

Competitor Information

Last Name: ______First Name: ______Date of Birth (mm/dd/yyyy): ______Gender: Male / Female (Circle one) Email Address: ______Street Address: ______Telephone: ______City: ______State: ______Zip Code: ______Country: ______Approximate Date Training in Chinese (internal and External) Began: ______(mm/dd/yyyy)

School Information

School Name: ______Style: ______Street Address: ______Telephone: ______City: ______State: ______Zip Code: ______Country: ______Shi-Fu Name: ______School Email Address: ______

Early Registration (Prior to July 1, 2021) $90 for the first event; $20 for each additional event Registration (July 1, 2021 to July 21, 2021): $95 for the first event; $25 for each individual event Current USKSF members receive $20 discount on first event. Discount does not apply to Events. Paper registration forms must be received with payment by July 16, 2021 to be accepted. THIS REGISTRATION FORM IS NOT COMPLETE UNLESS SIGNED. THANK YOU!

Waiver I, the undersigned, knowingly, without duress, do voluntarily submit my entry into the 2021 U. S. INTERNATIONAL KUO SHU CHAMPIONSHIP TOURNAMENT sponsored by the United States Kuo Shu Federation. I assume all risk of personal, physical and mental disabilities, injuries, death or losses, which may result from participating in this Tournament. Acting for myself, my heirs, personal representatives, and assignees, I do hereby release Huang, Chien-Liang, the United States Kuo Shu Federation, their officials, agents, representatives, employees, and all other related members from liability due to any injuries, illnesses or death incurred and any resulting legal claims, actions, suits, or controversies. I also understand that there is a great risk of injury, illness, or even death involved in all the competitive divisions, particularly fighting in a light contact or full contact events, and I assume full responsibility for all my actions, activities, or omissions during and in connection with the Tournament. I have read, understood, and agreed to abide by the rules of this event, and accept all responsibility and associated liability for infringement of such rules. Additionally, I am fully aware of my personal medical condition and hereby certify that I am free of any contagious diseases, and mentally and physically fit to compete. I choose to compete in every event for which I am registered, and I have not been compelled to compete by anyone (including my Instructor and/or martial arts school). I consent to the use of photography/video tapes of my participation in this event for promotional purposes, and hereby waive my rights to any form of compensation or claim.

Parent’s or Guardian’s signature required if contestant is less than 18 years of age.

Signature of Contestant: ______Date: ______

Signature of Parent/Guardian: ______

2021 United States International Kuo Shu (Kung Fu) Championship Tournament Important Notes for ALL Events

♦ Competition Levels are defined as follows:

BEGINNER - Years of training are < 2 years INTERMEDIATE - Years of training are > 2 years and < 4 years ADVANCED - Years of training are > 4 years Years of training are based on the TOTAL years of external and internal training combined.

♦ Competitor Age is based on the age at the time of competition. To compete in Lei Tai events the competitor must be a minimum of 18 years of age and less than 41 years of age at the time of competition.

♦ Competitors MUST be entered in the same age/experience level for ALL events entered.

♦ Competitors MUST compete with a different form in each event entered.

♦ All Short Weapon events are limited to single hand straightsword or broadsword. NO EXCEPTIONS

♦ All Long Weapon events are limited to long staff and . NO EXCEPTIONS

♦ All Weapons EXCEPT Broadword, Straightsword, Long Staff and Spear MUST compete in "Other” Weapon events.

♦ All Weapon events, including 2 person sets, are intended for traditional spring steel weapons unless the event name specifically indicates that it is a event. If in the Chief Judge’s opinion the weapon being used does not meet the criteria of a traditional weapon, the Chief Judge will make a 0.05 point deduction to the final score.

♦ Examples of Southern Short Hand Systems include: Southern Praying Mantis, Bak Mei, Wu Mei, and Style. Competition is NOT limited to the styles mentioned. If in the individual judge’s opinion the competitor is not exhibiting a Southern Short Hand form the judge will make a 0.05 point deduction to the score.

♦ Examples of Southern Long Fist Systems include: , Hung Ga, Hung Mei, Lee Ga, Southern Shaolin, Fu Jow Pai, Hung Fut, Crane Style, & White Crane. Competition is NOT limited to the styles mentioned. If in the individual judge’s opinion the competitor is not exhibiting a Southern Long Fist form the judge will make a 0.05 point deduction to the score.

♦ Group Tai Ji Quan divisions must contain between 5 to 10 members per team.

♦ Forms learned in containing characteristics not consistent with traditional kung fu forms should enter the Traditional Wushu Divisions available.

♦ There are NO refunds for ANY reasons.

♦ The Tournament Committee Reserves the right to combine categories within the same division. 2022 World Tournament Qualifying Events Only The following events are qualifying events for the next World Tournament being sanctioned by the TWKSF if the tournament is held prior to July 2022. Due to the global pandemic, the host, location and tournament dates are to be determined at a later date. If the event occurs after July 2022, competitors may have to re-qualify. First place winners in these events may choose to represent the United States on the US National Team, however, you do not have to compete in 2022 to compete in 2021. If you win first place in one of the events below, you will have to accept a position on the US National Team via email. Further instructions will be provided at the 2021 U.S. International Kuo Shu Championship Tournament.

Adult Advanced External Forms and Weapons Adult Advanced Internal Forms and Weapons 1 Adult Adv - Northern Form - Male 15 Adult Adv - Yang Style Tai Ji Quan Form - Male 2 Adult Adv - Northern Form - Female 16 Adult Adv - Yang Style Tai Ji Quan Form - Female 3 Adult Adv - Southern Form - Male 17 Adult Adv - Form - Male 4 Adult Adv - Southern Form - Female 18 Adult Adv - Xing Yi Quan Form - Female 5 Adult Adv - Straightsword () - Male 19 Adult Adv - Ba Qua Zhang Form - Male 6 Adult Adv - Straightsword (Jian) - Female 20 Adult Adv - Ba Qua Zhang Form - Female 7 Adult Adv - Broadsword () - Male 21 Adult Adv - Tai Ji Weapon - Male 8 Adult Adv - Broadsword (Dao) - Female 22 Adult Adv - Tai Ji Weapon - Female 9 Adult Adv - Long Staff (Gwun) - Male 23 Adult Adv - Xing Yi Weapon - Male 10 Adult Adv - Long Staff (Gwun) - Female 24 Adult Adv - Xing Yi Weapon - Female 11 Adult Adv - Spear () - Male 25 Adult Adv - Ba Gua Zhang Weapon - Male 12 Adult Adv - Spear (Qiang) - Female 26 Adult Adv - Ba Gua Zhang Weapon - Female 13 Adult Adv - Other Weapon (including double weapons) - Male 14 Adult Adv - Other Weapon (including double weapons) - Female

Weapon Fighting Lei Tai (Full Contact) Fighting 27 Adult Adv - Full Contact Long Weapon Free Fighting - Male 900 Adult - Lei Tai Male - Light (under 60kg) 28 Adult Adv - Full Contact Long Weapon Free Fighting - Female 901 Adult - Lei Tai Male - Middle C (60.1 to 65kg) 29 Adult Adv - Full Contact Short Weapon Free Fighting - Male 902 Adult - Lei Tai Male - Middle B (65.1 to 70kg) 30 Adult Adv - Full Contact Short Weapon Free Fighting - Female 903 Adult - Lei Tai Male - Middle A (70.1 to 75kg) 904 Adult - Lei Tai Male - Heavy C (75.1 to 80kg) 905 Adult - Lei Tai Male - Heavy B (80.1 to 86kg) 906 Adult - Lei Tai Male - Heavy A (86.1 to 92kg) 907 Adult - Lei Tai Male - Super Heavy (92.1 to 98kg) Kenpo 908 Adult - Lei Tai Male - Infinite (over 98.1kg) 31 Adult Adv - Kenpo Form - Male 909 Adult - Lei Tai Female - Light (under 55kg) 32 Adult Adv - Kenpo Form - Female 910 Adult - Lei Tai Female - Middle B (55.1 to 60kg) 33 Adult Adv - Kenpo Mass Attack - Male 911 Adult - Lei Tai Female - Middle A (60.1 to 65kg) 34 Adult Adv - Kenpo Mass Attack - Female 912 Adult - Lei Tai Female - Heavy B (65.1 to 71kg) 913 Adult - Lei Tai Female - Heavy A (71.1 to 77kg) 914 Adult - Lei Tai Female - Infinite (over 77.1kg) Adult External Forms and Weapon Only 35 Adult Int - Form - Kung Fu Northern Men 62 Adult Int - Long/Short Weapon - Men 36 Adult Int - Form - Kung Fu Northern Women 63 Adult Int - Long/Short Weapon - Women 37 Adult Int - Form - Kung Fu Southern Women 64 Adult Beg - Long/Short Weapon - Men 38 Adult Int - Form - Kung Fu Southern Short Hand Men 65 Adult Beg - Long/Short Weapon - Women 39 Adult Int - Form - Kung Fu Southern Long Fist Men 66 Adult Beg/Int - Other Weapon - Men/Women 40 Adult Beg - Form Kung Fu Northern - Men 67 Adult - Senior Weapon - Men 36 to 45 41 Adult Beg - Form - Kung Fu Northern - Women 68 Adult - Senior Weapon - Men over 45 42 Adult Beg - Form - Kung Fu Southern - Women 69 Adult - Senior Weapon - Women 36 to 45 43 Adult Beg - Form - Kung Fu Southern Short Hand - Men 70 Adult - Senior Weapon - Women over 45 44 Adult Beg - Form - Kung Fu Southern Long Fist - Men 71 Adult Adv - Weapon 45 Adult - Senior Form - Men 36 to 45 72 Adult Beg/Int - Wing Chun Weapon 46 Adult - Senior Form - Men over 45 73 Adult Adv - Kenpo Weapon - Men 47 Adult - Senior Form - Women 36 to 45 74 Adult Adv - Kenpo Weapon - Women 48 Adult - Senior Form - Women over 45 75 Adult Int - Kenpo Weapon - Men/Women 49 Adult Adv - Praying Mantis Form - Men 76 Adult Beg - Kenpo Weapon - Men/Women 50 Adult Adv - Praying Mantis Form - Women 51 Adult Beg/Int - Praying Mantis Form - Men 52 Adult Beg/Int - Praying Mantis Form - Women 53 Adult Adv - Wing Chun Form - Men/Women 54 Adult Beg/Int - Wing Chun Form - Men/Women 55 Adult Adv - Wing Chun Wooden Dummy 56 Adult Beg/Int - Wing Chun Wooden Dummy 57 Adult Int - Kenpo Form - Men 58 Adult Int - Kenpo Form - Women 59 Adult Beg - Kenpo Form - Men/Women 60 Adult Int - Kenpo Mass Attack 61 Adult Beg - Kenpo Mass Attack Adult 2-Man Sets Only Event # Adult Adv - Two Man Set Empty HandEvent # Adult Adv - Two Man Set Weapon 77 Partner Name: 80 Partner Name:

Event # Adult Int - Two Man Set Empty HandEvent # Adult Int - Two Man Set Weapon 78 Partner Name: 81 Partner Name:

Event # Adult Beg - Two Man Set Empty Hand 79 Partner Name: Adult Events Only 82 Adult Adv - Light Contact - Men > 200 lbs 100 Adult - Limited Step Push Hands - Men > 200 lbs 83 Adult Adv - Light Contact Sparring - Men 160.1 to 200 lbs 101 Adult - Limited Step Push Hands - Men 180.1 to 200 lbs 84 Adult Adv - Light Contact Sparring - Men < 160 lbs 102 Adult - Limited Step Push Hands - Men 160.1 to 180 lbs 85 Adult Adv - Light Contact Sparring - Women 103 Adult - Limited Step Push Hands - Men < 160 lbs 86 Adult Int - Light Contact Sparring - Men > 200 lbs 104 Adult - Limited Step Push Hands - Women > 160 lbs 87 Adult Int - Light Contact Sparring - Men 160.1 to 200 lbs 105 Adult - Limited Step Push Hands - Women 140.1 to 160 lbs 88 Adult Int - Light Contact Sparring - Men < 160 lbs 106 Adult - Limited Step Push Hands - Women 120 to 140 lbs 89 Adult Int - Light Contact Sparring - Women 107 Adult - Limited Step Push Hands - Women < 120 lbs 90 Adult Beg - Light Contact Sparring - Men 108 Adult - Freestyle Push Hands - Men > 200 lbs 91 Adult Beg - Light Contact Sparring - Women 109 Adult - Freestyle Push Hands - Men 180.1 to 200 lbs 92 Adult - Light Contact Long Weapon Free Fighting - Men 110 Adult - Freestyle Push Hands - Men 160.1 to 180 lbs 93 Adult - Light Contact Long Weapon Free Fighting - Women 111 Adult - Freestyle Push Hands - Men < 160 lbs 94 Adult - Light Contact Short Weapon Free Fighting - Men 112 Adult - Freestyle Push Hands - Women > 160 lbs 95 Adult - Light Contact Short Weapon Free Fighting - Women 113 Adult - Freestyle Push Hands - Women 140.1 to 160 lbs 96 Adult Beg/Int - Full Contact Long Weapon Free Fighting - Men 114 Adult - Freestyle Push Hands - Women 120 to 140 lbs 97 Adult Beg/Int - Full Contact Long Weapon Free Fighting - Women 115 Adult - Freestyle Push Hands - Women < 120 lbs 98 Adult Beg/Int - Full Contact Short Weapon Free Fighting - Men 116 Adult Adv - Chi Sao - Light 99 Adult Beg/Int - Full Contact Short Weapon Free Fighting - Women 117 Adult Adv - Chi Sao - Welter 118 Adult Adv - Chi Sao - Middle 119 Adult Adv - Chi Sao - Heavy 120 Adult Beg/Int - Chi Sao - Light 121 Adult Beg/Int - Chi Sao - Welter 122 Adult Beg/Int - Chi Sao - Middle 123 Adult Beg/Int - Chi Sao - Heavy Adult Internal Events Only 124 Adult Adv - Tai Ji - Chen Style Form - Men 140 Adult Int - Tai Ji Weapon - Men 125 Adult Adv - Tai Ji - Chen Style Form - Women 141 Adult Int - Tai Ji Weapon - Women 126 Adult Adv - Tai Ji - Cheng Man Ching Form - Men/Women 142 Adult Beg - Tai Ji Weapon - Men/Women 127 Adult Adv - Tai Ji - Other Style Form - Men 143 Adult Beg/Int - Xing Yi Quan Weapon - Men/Women 128 Adult Adv - Tai Ji - Other Style Form - Women 144 Adult Beg/Int - Ba Qua Zhang Weapon - Men/Women 129 Adult Int - Tai Ji - Yang Style Form - Men 130 Adult Int - Tai Ji - Yang Style Form - Women Event # Adult - Tai Ji Two-Man Set 131 Adult Int - Tai Ji - Chen Style Form - Men/Women145 Partner Name: 132 Adult Int - Tai Ji - Cheng Man Ching Form - Men/Women 133 Adult Int - Tai Ji - Other Style Form - Men Event # Adult - Group Tai Ji Form (5-10 members) 134 Adult Int - Tai Ji - Other Style Form - Women146 Team Name: 135 Adult Beg - Tai Ji - Yang Style Form - Men/Women 136 Adult Beg - Tai Ji - Other Style Form - Men/Women Event # Adult - Group Tai Ji Weapon (5-10 members) 137 Adult - Tai Ji Form (All Styles) - Men/Women 50 yrs & over147 Team Name: 138 Adult Beg/Int - Xing Yi Quan Form - Men/Women 139 Adult Beg/Int - Ba Qua Zhang Form - Men/Women Youth Events Only - Ages 15-17 148 Youth Adv - Form - Boy 15-17 yrs 154 Youth Adv - Short Weapon - Boy 15-17 yrs 149 Youth Adv - Form - Girl 15-17 yrs 155 Youth Adv - Short Weapon - Girl 15-17 yrs 150 Youth Int - Form - Boy 15-17 yrs 156 Youth Adv - Long Weapon - Boy 15-17 yrs 151 Youth Int - Form - Girl 15-17 yrs 157 Youth Adv - Long Weapon - Girl 15-17 yrs 152 Youth Beg - Form - B/G 15-17 yrs 158 Youth Adv - Other Weapon - Boy 15-17 yrs 153 Youth Adv - Kenpo Form - B/G 15-17 yrs 159 Youth Adv - Other Weapon - Girl 15-17 yrs 160 Youth Int - Long/Short Weapon - B/G 15-17 yrs 161 Youth Beg - Long/Short Weapon - B/G 15-17 yrs 162 Youth Adv - Kenpo Weapon - B/G 15-17 yrs Youth Events Only - Ages 13-14 163 Youth Adv - Form - Boy 13-14 yrs 169 Youth Adv - Short Weapon - Boy 13-14 yrs 164 Youth Adv - Form - Girl 13-14 yrs 170 Youth Adv - Short Weapon - Girl 13-14 yrs 165 Youth Int - Form - Boy 13-14 yrs 171 Youth Adv - Long Weapon - Boy 13-14 yrs 166 Youth Int - Form - Girl 13-14 yrs 172 Youth Adv - Long Weapon - Girl 13-14 yrs 167 Youth Beg - Form - B/G 13-14 yrs 173 Youth Adv - Other Weapon - Boy 13-14 yrs 168 Youth Adv - Kenpo Form - B/G 13-14 yrs 174 Youth Adv - Other Weapon - Girl 13-14 yrs 175 Youth Int - Long/Short Weapon - B/G 13-14 yrs 176 Youth Beg - Long/Short Weapon - B/G 13-14 yrs 177 Youth Adv - Kenpo Weapon - B/G 13-14 yrs Youth Events Only - Ages 11-12 178 Youth Adv - Form - Boy 11-12 yrs 184 Youth Adv - Long/Short Weapon - Boy 11-12 yrs 179 Youth Adv - Form - Girl 11-12 yrs 185 Youth Adv - Long/Short Weapon - Girl 11-12 yrs 180 Youth Int - Form - Boy 11-12 yrs 186 Youth Int - Long/Short Weapon - B/G 11-12 yrs 181 Youth Int - Form - Girl 11-12 yrs 187 Youth Beg - Long/Short Weapon - B/G 11-12 yrs 182 Youth Beg - Form - B/G 11-12 yrs 188 Youth Adv - Kenpo Weapon - B/G 11-12 yrs 183 Youth Adv - Kenpo Form - B/G 11-12 yrs Youth Events Only - Ages 9-10 189 Youth Adv - Form - Boy 9-10 yrs 195 Youth Adv - Long/Short Weapon - Boy 9-10 yrs 190 Youth Adv - Form - Girl 9-10 yrs 196 Youth Adv - Long/Short Weapon - Girl 9-10 yrs 191 Youth Int - Form - Boy 9-10 yrs 197 Youth Int - Long/Short Weapon - B/G 9-10 yrs 192 Youth Int - Form - Girl 9-10 yrs 198 Youth Beg - Long/Short Weapon - B/G 9-10 yrs 193 Youth Beg - Form - B/G 9-10 yrs 199 Youth Adv - Kenpo Weapon - B/G 9-10 yrs 194 Youth Adv - Kenpo Form - B/G 9-10 yrs Youth Miscellaneous Events and Mixed Age Events 200 Youth Adv - Kenpo Form - B/G under 9 yrs 209 Youth - Long/Short Weapon - B/G under 9 yrs 201 Youth Int - Form - B/G Under 9 yrs 210 Youth Beg/Int - Other Weapon - B/G 13-17yrs 202 Youth Beg - Form - B/G under 9 yrs 211 Youth Beg/Int - Other Weapon - B/G 12 yrs & under 203 Youth Int - Kenpo Form - B/G 13-17 yrs 212 Youth Adv - Kenpo Weapon - B/G under 9 yrs 204 Youth Beg - Kenpo Form - B/G 13-17 yrs 213 Youth Beg/Int - Kenpo Weapon - B/G 13-17 yrs 205 Youth Int - Kenpo Form - B/G 12 yrs & under 214 Youth Beg/Int - Kenpo Weapon - B/G 12 yrs & under 206 Youth Beg - Kenpo Form - B/G 12 yrs and under 215 Youth Adv - Kenpo Mass Attack - B/G 13-17 yrs 207 Youth - Wing Chun Form - B/G 13-17 yrs 216 Youth Adv - Kenpo Mass Attack - B/G 12 yrs & under 208 Youth - Wing Chun Form - B/G 12 yrs & under 217 Youth Int - Kenpo Mass Attack 218 Youth Beg - Kenpo Mass Attack 219 Youth - Wing Chun Weapon - B/G 13-17 yrs 220 Youth - Wing Chun Weapon - B/G 12 yrs & under 221 Youth Adv - Other Weapon - Boy 12 yrs and under 222 Youth Adv - Other Weapon - Girl 12 yrs and under Youth Combat Events Only 223 Youth Adv - Light Contact Sparring - Boy 15-17 yrs 237 Youth Beg/Int - Light Contact Sparring - Boy 15-17 yrs 224 Youth Adv - Light Contact Sparring - Girl 15-17 yrs 238 Youth Beg/Int - Light Contact Sparring - Girl 15-17 yrs 225 Youth Adv - Light Contact Sparring - Boy 13-14 yrs 239 Youth Beg/Int - Light Contact Sparring - Boy 13-14 yrs 226 Youth Adv - Light Contact Sparring - Girl 13-14 yrs 240 Youth Beg/Int - Light Contact Sparring - Girl 13-14 yrs 227 Youth Adv - Light Contact Sparring - Boy 11-12 yrs 241 Youth Beg/Int - Light Contact Sparring - Boy 11-12 yrs 228 Youth Adv - Light Contact Sparring - Girl 11-12 yrs 242 Youth Beg/Int - Light Contact Sparring - Girl 11-12 yrs 229 Youth Adv - Light Contact Sparring - Boy 9-10 yrs 243 Youth Beg/Int - Light Contact Sparring - Boy 9-10 yrs 230 Youth Adv - Light Contact Sparring - Girl 9-10 yrs 244 Youth Beg/Int - Light Contact Sparring - Girl 9-10 yrs 231 Youth Adv - Light Contact Sparring - B/G under 9 yrs 245 Youth Beg/Int - Light Contact Sparring - B/G under 9 yrs 232 Youth - Short Weapon Free Fighting - Boy 15-17 yrs 246 Youth - Chi Sao - B/G 12 yrs & under 233 Youth - Short Weapon Free Fighting - Girl 15-17 yrs 247 Youth - Chi Sao - B/G 13-17 yrs 234 Youth - Short Weapon Free Fighting - Boy 13-14 yrs 235 Youth - Short Weapon Free Fighting - Girl 13-14 yrs 236 Youth - Short Weapon Free Fighting - 12 yrs & under Youth 2-Man Sets Only Event # Youth - Empty Hand Two Man Sets 15-17 yrsEvent # Youth - Weapon Two Man Sets 15-17 yrs 248 Partner Name: 251 Partner Name:

Event # Youth - Empty Hand Two Man Sets 13-14 yrsEvent # Youth - Weapon Two Man Sets 13-14 yrs 249Partner Name: 252 Partner Name:

Event # Youth - Empty Hand Two Man Sets 12 yrs and underEvent # Youth - Weapon Two Man Sets 12 yrs and under 250 Partner Name: 253 Partner Name: Youth Internal Events Only 254 Youth - Tai Ji Form (All Styles) - Boy 13-17 yrs 255 Youth - Tai Ji Form (All Styles) - Girl 13-17 yrs Division levels are based on TOTAL years training in Martial Arts, including internal and external. You MUST compete in the same level and age group for all events. Enter Competitor Name: ______Early Registration Fees Registration Fees (Prior to July 1, 2021) DID YOU KNOW? (From July 1, 2021 to July 21, 2021) (list event #) (enter fee amt.)You Can (list event #) (enter amt.) Event #1: Event #1: $ Register and Pay $ fee: $85.00 online at fee: $95.00 Event #2: Event #2: $ www.usksf.org $ fee: $20.00 fee: $20.00 Event #3: Event #3: $ $ fee: $20.00 fee: $20.00 Event #4: Event #4: $ $ fee: $20.00 fee: $20.00 Event #5: Mail Registration Event #5: $ $ fee: $20.00 to: fee: $20.00 Event #6: USKSF Event #6: $ $ fee: $20.00 PO Box 927 fee: $20.00 Event #7: Reisterstown, MD Event #7: $ $ fee: $20.00 21136-0927 fee: $20.00 Event #8: U.S.A. Event #8: $ $ fee: $20.00 fee: $20.00 Event #9: Event #9: $ $ fee: $20.00 fee: $20.00 Event #10: For more Event #10: $ $ fee: $20.00 information call: fee: $20.00 Event #11: 443-394-9200 Event #11: $ $ fee: $20.00 or fax: fee: $20.00 Current USKSF Member 443-394-9202 Current USKSF Member $ $ Deduct $20.00 Deduct $20.00 www.usksf.org Compete in Lei Tai Event $ Compete in Lei Tai Event $ fee: $75.00 (no USKSF Discount) fee: $75.00 (no USKSF Discount) Office use only Buy USKSF Membership NOW Buy USKSF Membership NOW $ c / ck / v / mc / am / d $ ($55 for 2-year Membership) ($55 for 2-year Membership) cc apr: y / n

Total Amount Enclosed $ date post: Total Amount Enclosed $ KUO SHU LEI TAI FIGHTING Weight ______lbs. Gender: Male / Female (circle one) Lei Tai Registration Fee is $75 (includes blue and yellow T-shirt) E-Mail address for confirmation: ______1. You must be registered with payment by June 30, 2021. 2. Your 2021 Lei Tai Pre-Participation Health Questionnaire must be DATED ON OR AFTER 6/1/2021. 3. Your 2021 Lei Tai Pre-Participation Health Questionnaire must be SUBMITTED before 7/1/2021. 4. You will receive email confirmation of your accepted registration by July 12, 2021. 5. Confirmations will only be done via email. If WE do not have a confirmation for you, YOU WILL NOT FIGHT. 6. You must have personal insurance. 7. You must read and understand the Lei Tai rules and regulations. 8. You must be an amateur. 9. You or your School must be an active USKSF member. International Fighters must be from an active TWKSF country or be a USKSF member. 10. At the time of competition, you must be a minimum of 18 years of age and less than 41 years of age. 11. Mandatory Fighter Check-in and Lei Tai Rules Meeting Attendance on Friday, July 23, 2021. Registration Payment Information (to be used for Event AND Lei Tai Competition): circle one: cash / check (payable to USKSF) / visa / mastercard / american express / discover / money order

Credit Number:______Exp. Date: ______Amex Security #:______

Name on Card: ______