PAKAMUT INTERNATIONAL ASSOC.

PO Box 65552
Los Angeles, CA 90065-0552

Tournament Director/Promoter reserve the right to combine divisions

Forms Competition

[ ] (C1) – Juniors Boys and Girls 12 years old below, all weight
[ ] (C2) - Teens Boys and girls 13- 17 years old all weight
[ ] (C3) – Adults Men and Women 18 years old above

Full Contact Sparring

NOVICE (Training of one year or below)

[ ] (S1) – Juniors Boys and Girls 12 years and below (base on height)
[ ] (S3) - Boys 13-17 years old
[ ] (S4) -Girls 13-17 years old
[ ] (S5) - Men 18 years old and above, under 150lb (LW)
[ ] (S6)- Men 18 years old and above 150-171lbs. (MW)
[ ] (S7) Men 18 years old and above 172lbs.and above (HW)
[ ] (S8) Women all weight 18years old and above

ADVANCE Category

[ ] (S9) – Juniors Boys and Girls 12years old below all weight
[ ] (S10) - Teens Boys 13-17 years old all weight
[ ] (S11) – Men 18 years old and above, 150lbs under (LW)
[ ] (S12) – Men 18 years old and above 150-171lbs. (MW)
[ ] (S13) – Men 18 years old and above 172lbs.and above (HW}
[ ] (S14) – Seniors 40 years old and above all weight

SPECIAL ATTRACTION

[ ] (S14) BEST OF THE BEST open category (one round only)

[ ] (S15) Grand Masters Challenge
 5th Annual Open Full Contact Stick Fighting Championship
Best Of The Best / Grand Master’s Challenge
Wyndham Hotel Orange County
3350 Avenue Of The Arts Costa Mesa CA 92626
Tel. 323-350-8500 Email: flxroiles@yahoo.com

SIGN-UP FORM

CONSENT AND RELEASE STATEMENT

READ, UNDERSTAND BEFORE SIGNING

I, _________________________ by submitting this competition application form, understand that I am consenting to

release this event’s Tournament Promoter (s), all other persons associated with this event in any capacity from any
liability arising out of injuries, etc. that I may incur as a result of my attendance and/or participation at this event.
Furthermore, I hereby waive any compensation whatsoever for the use of picture, movies, media coverage, etc., utilized
by those associated with this event for profit making motives, at any time. I clearly understand that fighting aspect of
this sport and competition involves bodily contact. I have read and understand and agree to abide by rules governing
this event and assume all responsibility and any associated liability for infringement of such rules. Additionally, I am
fully aware of my personal medical condition and hereby certify that I am mentally and physically fit to compete at this
tournament. I also understand that the valid birth certificate should be presented upon demand in order to compete at
this tournament. I further understand that the registration fee is not refundable under any
circumstances.

(PLEASE FILL OUT THE FORM LEGIBLY)

Name ___________________________Age _______ Weight ______ Ht: _________ Rank: ____________

Address ______________________________ City__________________ State ______ Zip ____________

M/A School ______________________________ Home Phone ___________________________________

Style/Method / Art ___________________________ Instructor ___________________________________

Email Address: _________________________________________________________________________

Signature: ____________________________________ Date: ____________________________________

Signature: ____________________________________ Date: ____________________________________

Parent or person responsible for assuming responsibility for the said minor