Battle at The Shore III
Registration Form

Name___________________________________________       Birth Date________
Address_________________________________________       Age ____________
City,State,Zip ____________________________________        M_______ F______
Phone No.________________________                                     Weight __________
Email____________________________
Name of School_______________________ Name of Instructor_____________________

Competition Fees - No Refunds -No exceptions-Please don’t ask
Mail in registration must be received by Oct.14, 2011.   
                                                                     
1 Division $65/ at the door $75
2 Divisions add $20
3 Divisions add $20       

Spectator Fee $10 in advance/ $15 at the door
(Children under 3 are free)                                                                                            

# of divisions______X____=_______
# of spectators_____X___=________
                                                                                                                                                                                  
Please indicate Rank for each division enter below: (Beg/ Int./ Adv.)

BJJ Gi_____ No –Gi________ Single Stick ______Double Stick________ Forms________
Sparring_________ Knife Fighting________

*Make money order payable to: Joe Parker. Personal Checks will not be accepted.
*Mail Registration form to: Joe Parker, PO Box 113, Absecon, NJ 08201


For add. info., joe@modernfightingconepts.com/(609)646-2113

Liability Waiver- I the undersigned, do hereby voluntarily submit my application for attendance and participation in the Battle at
The Shore Tournament. I hereby assume full responsibility and forever waive any and all claims against The Battle at the Shore,
Modern Fighting Concepts Academy, directors, judges, referees, operators, sponsors, or any other participants or affiliations for any
and all damages, injuries or losses that I may sustain or incur while attending or participating in the Tournament, individual or
otherwise. I represent to all the aforementioned that I am in good health and that I have no disabilities, impairments, illness,or
ailments preventing me from participating in said tournament. I fully understand that any and all medical aid or treatment
administered to me as a result of any injury will be of “First Aid” nature only. I further consent that any pictures, video or film furnished
by me or taken of me in connection with this tournament may be used by the promoters or directors for publicity,promotions, or
advertisement via television, magazines or any other manner they may deem necessary. I waive any and all compensation in regards
thereto. I, the undersigned, do hereby agree to abide by all rules, regulations, and ceremonies which apply to the Battle at the shore. I
further understand that if I violate the said rules, I may be disqualified with no refund of any entry fees. IF UNDER THE AGE OF 18YRS.
OLD, APP. MUST BE SIGNED BY THE PARENT OR LEGAL GUARDIAN.

Contestant’s Signature____________________________________________ Date__________

Parent or Guardian’s Signature ____________________________________ Date__________