Greetings!

On behalf of Nippon Karate-do, Purdue University and the West Lafayette Shotokan Karate Club, we regretfully remind
you of the recent disaster that has befallen on Japan. The Eastern Japan Great Earthquake Disaster (東日本大震災) was
the result of a 9.0 (out of 10.0) –magnitude earthquake that struck Japan’s coast at 14h46 Japan Standard Time on March
11, 2011. We are reminded by the news of the 400 km of coastline affected; however, it is difficult for us to imagine the
actual severity of this disaster by merely looking at numbers.

400 km is roughly the distance from Chicago, Illinois to St. Louis, Missouri. This distance separates Illinois into two parts
from the northeast to the southwest.

Japan and its territories was the birthplace to the many forms of karate-do. Many of us spend the majority of our lives
doing, speaking, and even thinking about karate-do. To give back to the country who gave us our life’s passion, Nippon
Karate-do, Purdue University and the West Lafayette Shotokan Karate Club has partnered together to host the Japan
Disaster Relief Karate Tournament.

We have worked with Purdue University to receive space (at a discounted rental cost) for this charity event. Also, we
have worked with equipment suppliers to provide us with supplies at reduced rates. All we need is your participation in
our event in order to meet our goal of raising funds to donate to the Red Cross Society.

W are able to maximize our donation to the Red Cross Society by lowering our costs of operation through generous
donations. 100% of the proceeds from this tournament will be donated.

Within this packet are the necessary information and registration forms to attend this event. Please consider attending this
event as a way to give back to the country that gave you karate.

Ossu,

_________________________ _________________________ _________________________

Dr. Marc Rogers PhD Vincent Chung Kakei Lin
Chief Instructor Club President/Event Coordinator Club Vice-President/ Director Public Relations
WHEN: Sunday, May 8, 2011
WHERE: Purdue Memorial Union - South Ballroom (connected to the Union Club Hotel)
101 N. Grant Street · West Lafayette, Indiana 47907

INFORMATION: Vincent Chung: vchung@purdue.edu Kakei Lin: linj@purdue.edu

TIME: Kata starts at 9:30 AM Kumite starts at 1:00 PM

LATE REGISTRATION: Add $15 late fee to registration if Late registration at the door from 8:00 to
postmarked after 8:30 AM only.
May 1, 2011 or at the door.

COMPETITOR FEES: $45 for all events (kata and kumite)

$10 discount if university student (must bring university ID to check-in).

CHECK-IN: Competitors must check-in at the tournament site at least 15 minutes prior to
your event start time.

PRE-REGISTRATION: Pre-Registration MUST be Mail Registration & Payment to:

postmarked by: ATTN: Dr. Marc Rogers
Sunday, May 1, 2011 Purdue University
656 Oval Drive
Payment MUST be included West Lafayette, Indiana 47907
(check/money order)
Make payable to: Dr. Marc Rogers

SPECTATOR FEES $3.00: Sr. Citizens (55 yrs. & older) $5.00: Student ID
$7.00: Adults (17 - 54 yrs.) Free: Mothers
(Paid at the door) $3.00: Children (8 - 16 yrs.) Free: Press Pass
$10.00: Whole family Free: Children (7 yrs. & under)
Free: Club/Dojo Instructors

OFFICIALS: REPORT AT 8:00 AM, OFFICIALS’ MEETING 8:15 AM SHARP DRESSED IN

OFFICIALS’ UNIFORM: WHITE DRESS SHIRT, BLUE TIE, GRAY SLACKS & BLACK
SHOES

HOTELS SUGGESTED: Union Club Hotel Hilton Garden Inn

101 N. Grant Street, West Lafayette, IN 356 E. State Street, West Lafayette, IN
800.320.6291 765.743.2100

Holiday Inn Hotel

515 South Street, Lafayette, IN
765.423.1000
DIVISIONS: JUNIORS: (Boys/Girls): 16 yrs and under. (Age as of Tournament Date)

DIVISIONS: Beginner: (10 kyu - 7 kyu)

Intermediate: (6 kyu - 3 kyu)
Advanced: (2 kyu & up)
NOTE: Kata divisions will be run by single or double eliminations per tournament
director discretion depending on number of entries. Kumite divisions may be
combined depending on number of entries.
EVENTS:  KATA:
Beginner: Your kata choice
Intermediate: 2 alternating kata
Advanced: 3 alternating kata
 KUMITE:
Shobu-sanbon

ADULTS: (Men/Women): 17+ yrs. (Age as of Tournament Date)

DIVISIONS: Beginner: (10 kyu - 7 kyu)
Intermediate: (6 kyu - 3 kyu)
Advanced: (2 kyu & up)
EVENTS:  KATA:
Beginner: Your kata choice
Intermediate: 2 alternating kata
Advanced: 3 alternating kata
 KUMITE:
Shobu-sanbon

RULES: Traditional Karate / Japan Karate Federation Rules

UNIFORMS: White Gi ONLY for all divisions. Limited to one patch.

SPARRING REQUIRED: RECOMMENDED:
EQUIPMENT:  JKA, JKF, AAU, WKF or traditional fist  Foam headgear (white only)
guards  Female Chest protector
 Mouthpiece  Shin/instep (JKF, AAU, WKF)
 Groin cup (males)

ONLY SAFETY GLASSES OR SOFT CONTACT LENSES MAY BE WORN FOR SPARRING
NO METAL ACCESSORIES MAY BE WORN (except for items with religious purposes)
COMPETITOR’S NAME:________________________________________________________ BIRTH DATE__________________

ADDRESS:_____________________________________________________ CITY, STATE & ZIP__________________________

E-MAIL ADDRESS:___________________________________________ PHONE: (___________)__________________________

Area code

CLUB/DOJO:________________________________________________ CHIEF INSTRUCTOR:__________________________

DOJO ADDRESS:_____________________________________________ CITY, STATE & ZIP: ___________________________

(If other than from Purdue/West Lafayette)

I hereby for myself, my executor(s), forever and always agree to save and hold harmless Nippon Karate-do, Purdue University,
Purdue University, the instructors, volunteers, and anyone else involved for any liability or injury I may sustain by the way of
traveling to or from, participating in or other direct or indirect involvement in said karate event I have entered. In addition, I hereby
for now and forever, accept any and all responsibilities for any actions in conjunction with said event and the traveling to or from or
participation in said event.

Competitor’s Signature: ________________________________________________ Date:__________________

Parent/Guardian’s Signature:____________________________________________ Date:__________________

(If under 18 years of age)

*** FILL-OUT FOR EACH EVENT ***

JUNIORS KATA
JUNIOR: 7/under Junior: 8 – 12 yrs Junior: 13 – 16 yrs
[ ] Beginner kata [ ] Beginner kata [ ] Beginner kata
[ ] Intermediate/Advanced kata [ ] Intermediate/Advanced kata [ ] Intermediate kata
[ ] Advanced kata
JUNIORS KUMITE
JUNIOR: 7/under Junior: 8 – 12 yrs Junior: 13 – 16 yrs
[ ] Beginner kumite [ ] Beginner kumite boys [ ] Beginner kumite boys
[ ] Intermediate/Advanced kumite [ ] Beginner kumite girls [ ] Beginner kumite girls
[ ] Intermediate/Advanced kumite [ ] Intermediate kumite boys
boys
[ ] Intermediate/Advanced kumite [ ] Intermediate kumite girls
girls
[ ] Advanced kumite boys
[ ] Advanced kumite girls
ADULT KATA (17+ yrs)
[ ] Beginner kata [ ] Intermediate kata [ ] Advanced kata
ADULT KUMITE (17+ yrs)
[ ] Beginner kumite men [ ] Intermediate kumite men [ ] Advanced kumite men
[ ] Beginner kumite women [ ] Intermediate kumite women [ ] Advanced kumite women
Nippon Karate-do, Purdue University
Medical Release / Treatment Permission Form

I,___________________________________________________, hereby give my permission,

(please print clearly)
in the event that I (or my child) am unable to make a conscious medical decision for treatment,
to the on-call medical staff, to act on my (or my child’s) behalf and in my (or my child’s) best
interest, to receive any medical care they deem necessary.

Participant’s Name:____________________________________________
(please print clearly)

Emergency Phone #:___________________________________________

X____________________________________________ ________________________
Athlete’s Signature or Parent (if under 18 years) Date

Obligatory Medical Information

List any possible life threatening or serious medical conditions:______________________________________________

_________________________________________________________________________________________________

List any known life threatening allergies:________________________________________________________________

__________________________________________________________________________________________________

List any medications being used:_______________________________________________________________________

__________________________________________________________________________________________________

Name of family physician(if possible):___________________________________________________________________

Physician’s Phone(s) # (if possible):_____________________________________________________________________