NOTE: For those competing in ADVANCED Changquan or Nanquan
who intend to perform moves which qualify for difficulty points -- please list the following information for each movement,
using the provided difficulty forms on the site. Mail the difficulty forms along with your registration.
Competitor Information:
Name:
First: _____________________ Middle: _____________ Last: _____________________
Birthdate (mm/dd/yy): ___ / ___ / ___
Gender: F / M
Level:
___ Beginner (< 1 yr experience)
___ Intermediate (1-3 yrs experience)
___ Advanced (> 3 yrs experience)
Competitor Class:
___ Currently enrolled student - Undergraduate
___ Currently enrolled student - Graduate
___ One-year alumnus or non-enrolled
Competing for All-Around? (Advanced only) Y / N
Address 1: _____________________________________
Address 2: _____________________________________
City: _____________________________________
State/Province: ___________________
Zip/Postal code: ___________________
Country (if not USA): _____________________________
Phone number: ________________________
Email address: ____________________________________________
Emergency contact information:
Full name: ________________________________
Phone number: ________________________________
Relation: ________________________________
College or university (full name): _______________________________________________________
Instructor (and wushu school if different from college or university): ________________________________
Event Information:
Check all that apply. You may not change events once the registration form has
been submitted.
For open forms: specify the style.
For team group sets: enter your team name, contact name, and contact
email address.
___ Contemporary - Changquan
___ Contemporary - Nanquan
___ Contemporary - Wushu Open Empty Hand
________________________________
___ Contemporary - Wushu Open Weapons
________________________________
___ Internal - Chen Taiji
___ Internal - Yang Taiji
___ Internal - 42 Form Combined Taiji Compulsory
___ Internal - Open Empty Hand
________________________________
___ Internal - Open Weapons
________________________________
___ Internal - Taiji Sword
___ Traditional - Open Empty Hand
________________________________
___ Traditional - Open Weapons
________________________________
___ Broadsword
___ Straightsword
___ Staff
___ Spear
___ Nangun
___ Nandao
___ Team Group Set
Team Name: ________________________________
Contact Name: ________________________________
Contact Email: ________________________________
Registration Fee:
Please make checks payable to Stanford Wushu.
___ $35: Registration by early deadline February 16, 2008 (incl first event)
___ $45: Registration by final deadline February 23, 2008 (incl first event)
___ $5: Each additional event
___ TOTAL
Mail to:
Stanford Wushu
PO Box 17573
Stanford, CA 94309
Waiver/Release Agreement
I, the undersigned, acknowledge that I have voluntarily chosen to participate
in the Twelfth Annual National Collegiate Wushu Championships sponsored by the
Stanford Wushu Club. I have full knowledge of the risks that this activity presents,
including travel to, participation in, and returning from the activity or event.
I understand that by being permitted to participate in martial arts activities,
I agree to assume any and all risks of injury or death. I further understand
and agree to assume responsibility for all risk of theft, loss, or damage of
personal property which occurs at any time arising out of my participation in
martial arts activities.
I understand and agree that as a condition of participation in martial arts activities, I further agree to release liability and indemnify Stanford University, the officers, directors, agent, employees, assigns, successors, or lessors from any damage, injury, death to myself or to any person or property, in any way connected with my participation in martial arts activities.
I understand and agree that I have carefully read this agreement and fully understand all of its terms and conditions. I understand that this is a release of liability which could legally prevent me from filing suit or making any other claim for damages in the event of my death or injury to me. With this knowledge, I am entering into this agreement freely and voluntarily. I agree that it is binding on me, my assigns, and legal representatives.
I understand and agree that I have read all of this waiver and release, have provided all necessary information, and have signed in the appropriate places.
I also give permission to use, reprint, and reproduce any photograph or video taken of me and any written material supplied by me during martial arts activities.
Participant's Signature: _____________________________________________
Date Signed: ____________________
Parent or Guardian's Signature *: _____________________________________________
Date Signed: _____________________
* Required of individuals under 18 years of age