Presented by

Kempo Martial Arts

419-885-1519
Sponsored by
Ohio Michigan Invitational
Championship Point Series
Multi Martial Arts Tournament
Date: Sunday, September 14, 2014
Registration
Children 12:00 p.m.-1:00 p.m.
Adults 12:00 p.m.-2:00 p.m.
Competition
Children 1:00 p.m.-2:30 p.m.
Adults 2:00 p.m.-4:00 pm.
Cost: $45 for participants; $3 for spectators
Early birds: $40 before September 10
th


Future events:
2014 Tournaments 11/23/14
2015 Tournaments 2/22/15, 4/26/15, 10/11/15, 11/22/15
Please complete ALL information
If registering by mail, please send payment and completed form to: Kempo Martial Arts 6801 W. Central Ave. Suite E., Toledo, Ohio 43617
MasterCard and Visa payments payments accepted by phone or in person.
Division(s): Fighting Forms Open (includes weapons, breaking, non-traditional forms and self-defense)
Divisions include separate WOMENS Sparring, SENIOR WOMEN Sparring, SENIOR MENS Sparring
Previous OMI Participant? ________

Name:______________________________________________Age:_________Birthdate:______________Phone: (______)____________________


Email address _____________________________________________________@ _____________________________________


Address:________________________________________________________________________________________________________________
Street City State Zip

Rank_______________________ Date rank was received _____________________


Name of Karate School:_________________________ Instructors Name:______________________________________________


May we share your contact information with associates who promote and market events and products? ______YES ______NO

Signature_____________________________________________________Date:_________________
(competitor or parent/guardian if competitor is under 18)

Waiver: I release all persons associated with the Kempo Martial Arts Centers from any liability due to injuries, etc.
that I may incur as a result of my attendance and/or participation at this event. I clearly understand that the fighting
aspects of this sport and competition involve bodily contact. I have read and agree to abide by the rules associated
with 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 event. I also understand that a valid birth certificate or acceptable proof of age must be presented upon request.
# of events __________

# of Spectators __________

TOTAL AMOUNT PAID _____________
Clerks Initials: _____ Receipt #______________
Pmt. Method: Check Credit Card - Cash
Check payable to: KEMPO MARTIAL ARTS
Call 419.473.1519 with CREDIT CARD payment
Card #:
Exp date:
Adult Black Belts Win up to
$500 in Cash Prizes
$100 Senior Men Black Belt Fight
$100 Black Belt Men Fight
$100 Black Belt Women Fight
$100 Senior Bk Blt Women Fight
$100 Forms/Open Grand Champ
(Minimum 3 competitors. Single elimination.
Seniors 40 and older.)




Saint Clement Hall
2990 Tremainsville Road, Toledo, Ohio 43613