IntMAT Shaolin 2010
International Shaolin Kung Fu Tournament
9 AM to 6:30 PM, April 18, 2010
CPAA Arts Center, 6148 Bollinger Road, San Jose, CA 95129
Website: www.cpaasv.com Tel: 408-973-8276, Fax: (408) 973-8255
Competitor Registration Form Page 1
Fill Page 1 + Page 2A for Wushu (Chinese style); Page 1+ Page 2B for Capoeira (Brazilian style); Page 1 + Page 2C for Taekwando (Korean style); Page 1 + page 2D for karate (Japanese style); Page 1 + 2E for others.
Mail this form (page 1 & Page 2) and payment to IntMat, 1387 Bing Drive, San Jose, CA 95129, USA.
Liability Waiver: For the acceptance of my participation and presence in the said IntMAT Shaolin 2010, I here by waive, release, and discharge Chinese Performing Arts of America, San Jose, from and against any and all liability for any loss, personal injury, including death, or property damage that may have arisen out of, or in any way connected with, my participation at the aforementioned event, even though that liability may have arisen out of negligence or carelessness on the part of the persons or entities mentioned above and herein released, but do not release the above mentioned persons or entities from their fraudulent or intentional acts or for their negligent violations of statutory law. If the competitor is under 18, this release and consent must also be signed by a parent or legal guardian. I have read the above, understand its meaning and voluntarily sign it.
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Individual Competitor printed name Signature Date
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Head of Team/Name of Guardian if competitor under 18 Signature Date
Competitor Information:
Age: ______Birth Date: ______Years Experience:______Gender: ______
Email:______Phone (day): ______Phone (eve.): ______
Address:______
Martial Arts School______Style:______
Emergency Contact: ______
Name (print) Phone Relationship
Registration Fee (Admission to all activities all day 4/18): Individual______
Regular Registration, before March 30, 2010 $40 ___ (1 event)
Late Registration, before April 15, 2010 $45 ___ (1 event)
Registration at door on April 18, 2010 $60 ___ (only 1 event allowed)
(From Page 2) additional events: _____ X $10 = $____ Total $ ______nonrefundable
For group competitors: $10 for each additional teammate and one trophy/medal for a winning team and a certificate
for each teammate.
Opening Ceremony: 8:30 AM. All competitors have to participate and report to registration booth at 7:30 AM.
Prizes: 1st Place: trophy and certificate. 2nd or 3rd place: medal and certificate. All winners are present to receive prizes.
Grand Shaolin Champion registration: $120 ____ (includes 3 events & lunch coupon) Prize: $300 cash, trophy, and certificate; a trophy and a certificate to 2nd and 3rd winners. . Minimum 3 competitors are required for the competition.
Masters Strength & Unity performed by teachers of martial art schools at 12 noon.
Payment: registration fee $______
Or, pay by credit card: ______Expiration date:______
Circle one (VISA, Master Card, American Express, or Discovery)
IntMAT Shaolin 2010
International Shaolin Tournament
Gender: / Age Category: / Experience:Male………... / 7 and under…………. / < 2 years (Beginner)……
Female…….. / 8 -12………………….. / 2 - 3 years (Intermediate)..
13 -17……………….... / 4+ years (Advanced)…..
18 -35…………..……..
36 + ………………..
Event Registration:
Please check the boxes to the right of the events you will be competing in. Events may be split, merged,
or eliminated as necessary. Each event costs $10 to enter.
Traditional Wushu:
Hand Forms: / Weapon Forms:
Northern Style...... / Brd Sword……………………………..
Southern Style...... / Sword……………………………..…….
Spear……………………………..…….
42-Form Tai Chi quan.……………… / Staff……………………………..…….
Form Yang……………………………. / Other Weapons______
Form Chen…………………………….
Other Tai Chi…………………………… / 42-Form Taichi Straight sword ………………
Ba-Kwa Hsing-I Pa-Chi. …………… / Other Weapons ______
Contemporary Wushu:
Hand Forms: / Weapon Forms:
Long Fist………………………………
Southern Fist…………………………
TaiChi quan.………… ……………… / Straightsword……………………………….
Broadsword…………………………………
Southern Broadsword……………………..
Spear………………………………………..
Staff………………………………………….
Southern Staff………………………………
Other Wushu:
Other ______/ Total Number of Events………………………
Shaolin Individual All Round (3 Forms)
（Must Pick One of Each: Fist Form, Short Weapon, Long Weapon）
Gender: Experience: / Gender: Experience:
Male ……… / 4+years Only… / Long Fist / Broadsword…………
Female …… / (Advanced) / Southern Fist / Straight Sword………
Tai chi Fist / Spear …………………
For more Info, see Website: www.IntMAT.com / Staff ……………………
Participants’ name: ______ Total Number of Events…………………
Competitor Registration Form Page 2A (Wushu)
Registration content subject to change without prior notices.