2004 IKF NORTH AMERICAN AMATEUR CHAMPIONSHIP REGISTRATION FORM
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• Print out this Form, Complete & MAIL to the IKF with your NAT Registration Fee of $45.00.
• Provide a bio of your fight history to include opponents, result, when & where.
• Include a HEADSHOT PICTURE of yourself. If no Headshot Photo included you will be charged $10 at event.
• Mail To: IKF, P. O. Box 1205, Newcastle, CA, 95658. ATTENTION: NAAC Tournament.
• PLEASE PRINT NEATLY - Registration Forms "Without Fees" will be Disposed of.
  1. FIGHTERS Name:_____________________________ LIVING TOWN: ________________________
  2. What COUNTRY Are You From: _____________________________________________
  3. Current Age: ____ & Birthday (month, day & year): ___/___/___
  4. IF YOU ARE OVER 35 years old, you will NEED to include a VIDEO TAPE of your fighting ability.
  5. Height in Feet & Inches:____'____" - Weight in Pounds You Will Fight At: ______ Lbs.
  6. FIGHTERS MAILING Address: ______________________________________
  7. City: _______________________ State/Prov: _____________ Zip/Postal Code: _______________
  8. FIGHTERS Phone Number: _____________________ Fax: _______________________
  9. TRAINER: (SELF if you train yourself) ______________________ Gym Name: __________________
  10. TRAINERS GYM MAILING Address:____________________________________
  11. City: _______________________ State: _____________ Zip Code: _____________
  12. TRAINERS Phone:________________ Fax: ________________ e-Mail (If One):______________
  13. FIGHT RECORD: W=Wins, L=Loses, D=Draws, KO'S & TKO's=Knockounts or Technical Knockout.
  14. W:___ L:___ D:___ KO'S/TKO's:___ AM BOXING, If any: W:___ L:___ D:___ KO'S/TKO's:___
  15. Last Bout: Opponents Name: ___________________ Where:___________________________
      • Date of Bout:___/___/___ Result (Win or Lose, type of decision): _________________

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RELEASE FROM LIABILITY
This RELEASE of Liability is a Legal Contract binding upon You, The IKF (International Kickboxing Federation) and any and all companies, federations or organizations associates, officials, employees and staff of this event. READ IT CAREFULLY AND OBTAIN LEGAL ASSISTANCE IF YOU DO NOT UNDERSTAND IT.

1. Voluntary Application. I, the undersigned, acknowledge and state that I have voluntarily applied to compete in the 2004 IKF North American Championship Tournament.
2. Assumption of risk. I am aware and understand that in general, full contact fighting is a dangerous and hazardous activity, and in particular, the techniques and methods of this convention, all in which as a competitor in this competition, I shall be participating, is an extremely dangerous and hazardous event. I am voluntarily and of my own free will submitting an application to compete in this event with full knowledge and understanding of the hazards involved. I hereby consent and agree to completely accept alone any and all risks of injury or death, and I verify and confirm this statement by placing my initials here: ____
3. Release. In consideration for (a) being accepted as a competitor of the 2004 IKF North American Championship Tournament. , (b) being entitled to participate in activities conducted and sponsored by the IKF (International Kickboxing Federation and (c) being permitted to use facilities and equipment, whether owned or leased by The IKF (International Kickboxing Federation) and all associates, officials, employees, staff and fellow participants and trainers/coaches. I hereby agree that I, my heirs, distributees, guardians, successors in interest and legal representatives (collectively referred to as "Releasor") will not make a claim or file an action or suit against, sue, or attach the property of (a) the 2004 IKF North American Championship Tournament. which would include The IKF (International Kickboxing Federation) or any and all of their officials, affiliated organizations, and/or their directors, officers, employees, agents or managers, fellow participants, trainers, and (b) any or all manufacturers, distributors, wholesalers, suppliers and/or retailers of the facilities and equipment I will use in connection with any and all activities conducted and/or sponsored by The IKF (International Kickboxing Federation) and any and all of these companies, federations or organizations associates, officials, employees and staff (collectively referred to as the "suppliers"), (The IKF (International Kickboxing Federation) and any and all of these companies, federations or organizations associates, officials, employees and staff, and the Suppliers shall collectively be referred to as "Releasees), for damages, injury, emotional distress claims, bodily injury claims, and punitive damages, whether known or unknown, foreseen or not, due to or resulting from the acts, conduct, negligence, or misfeasance of, or omissions or failures to act by, the Releasees, or any of them.
4. Application of State Law. In further consideration of (a) being accepted as a competitor in the 2004 IKF North American Championship Tournament., (b) being entitled to participate in activities conducted and sponsored by The IKF (International Kickboxing Federation) and all of these companies, federations or organizations associates, officials, employees and staff, and (c) being permitted to use facilities and equipment, whether owned or leased by The IKF (International Kickboxing Federation) and any and all of these companies, federations or organizations associates, officials, employees and staff, I hereby agree that this Release from Liability shall be interpreted under and construed in accordance with the South Carolina State law only, without the benefit of and fully disregarding all South Carolina State conflicts of laws provisions, so that any and all disputes, contentions, disagreements or controversies arising from or related to (a) this Release from Liability, (b) the application for acceptance into the Challenge, or (c) my participation in any and all activities conducted or sponsored by The IKF (International Kickboxing Federation) and any and all of these companies, federations or organizations associates, officials, employees and staff, shall be interpreted under and in accordance with only the South Carolina State law regardless of my domicile or residency; and that the only court in which an action or suit may be brought in connection with the foregoing shall be the court of original jurisdiction of the State of South Carolina. Further, I waive any right I may have to assert the doctrine of forum non conveniens or similar doctrine or to object to venue with respect to any proceeding brought in accordance with this Release, and I stipulate that the South Carolina courts shall have in personam jurisdiction and venue over me for the purpose of litigation any dispute, controversy, or proceeding arising out of or related to this Release, The IKF (International Kickboxing Federation) and any and all of these companies, federations or organizations associates, officials, employees and staff.
5. Health Advisory and Condition. I hereby acknowledge and understand that participating in this event involves extremely strenuous physical activity and heavy physical contact, and that I have been advised to consult a physician before commencing and undertaking such activity. I hereby represent that, to the best of my knowledge, I am in good physical health and condition, sufficient to undertake this dangerous and hazardous competition.
6. Knowing and Voluntary Execution. I hereby declare that I have read this Release from Liability, and that I fully understand the meaning and importance of its contents. I acknowledge that this Release is a binding contract among The IKF (International Kickboxing Federation) and any and all of these companies, federations or organizations associates, officials, employees and staff and myself, and that under this contract I am releasing The IKF (International Kickboxing Federation) and any and all of these companies, federations or organizations associates, officials, employees and staff from all liability for claims I may have against them. I further declare and represent that I am at least 18 years of age, that I have full legal capacity to be bound by this contract, and that I am signing this contract of my own free will and accord.

Executed at ____________________, on this ______day of ______________________ , in the year 2004.

Applicant/Releasor:
Signature: _________________________________ Print Name: _________________________________

There are NO Registration Fee REFUNDS for ANY IKF Tournament Event.