Pre-Registration (No Registration On-site)

GREAT LAKES CUP INVITATIONAL TAEKWONDO CHAMPIONSHIPS
May 31st,Chipewa Middle School, 4000 Okemos Road, Okemos, Michigan, 48864 
Name: (First, Last) _____________________________________	Sex (M/F) ___     Age as of 5/31/08 ________________

Address  _____________________________________________  City  _____________________________  Zipcode  _________

Weight _______lb.      Height:  __________   Rank (Gup/Dan ) _________    Belt Color _______  Phone (     ) ________

Number of Tournament Experiences (Sparring):  __________ (This information will be used to help match students evenly)

TKD School Name __________________________   email address___________________________________________________ 

Check one
_____	Novice ( 7th – 10th gup)    white,  yellow, orange, green          Sparring _____ Forms _______ Breaking  ____
_____   lntermediate (4th - 6th gup)       green and blue                  $50 one event; $60 two events; $70 three events
_____	Advanced (1st- 3rd gup)            brown and red                   On-Site registration not available
_____	Black Belt                                black	                   Fee submitted $ _________


	Make Check/Money Order payable to:	Shinns TKD
       Send pre-registration form and fee to:	Shinn's Taekwondo Academy
	2189 W. Grand River Ave., Suite #2. Okemos, MI 48864  (517) 347-9062
	
Pre-registration by mail must be postmarked by May 23rd, 2008
To Register Online, go to:  www.shinnstkd.com/CupMain.html
Online registration after May 25th (and before midnight May 29th) will be charged an additional $10 fee

T-Shirts:  To order GLC T-Shirts for $10 ($15 at Tournament), complete the boxes and enclose payment:
Choose shirt size:  Child M(10-12)  Child L (14-16)  Adult: S  M  L  XL  XXL ($2 extra for XXL)
Size:  __________  Quantity:  ___________   Fee enclosed for T-Shirts:  $__________

Event Fee __________ +  T-Shirt Fee  __________ =   Total Fee  $__________

LIABILITY WAIVER
In consideration of being allowed to participate in any way in the Great Lakes Cup athletic program or related events,
the undersigned acknowledges, appreciates and agrees that, for myself and on behalf of my heirs, assignees, personal
representative and the next of kin, hereby release and hold harmless the Great Lakes Cup, Shinn's Taekwondo Academy, Inc.,
their officials, officers, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and,
if applicable, owners and lessors of premises used to conduct the event ('Releases") with respect to any and all injury,
disability, death, or loss or damage to person or property, whether arising from negligence of the releasees or otherwise.

The risk of injury from the activities involved in this program is significant, including the potential of permanent paralysis
and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does
exist: and I knowingly and freely assume all such risks, both known and unknown, even if arising from negligence of the releasees
or others, and assume full responsibility for my participation.

I willingly agree to comply with the stated and customary terms and conditions of participation. If however I observe any unusual
significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of
the nearest official immediately
This is to certify that I (or parent/guardian with legal responsibilities for this participant) HAVE READ THIS RELEASE OF LIABILITY
AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND
SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I do consent and agree to release as provided above of all RELEASEES, and for
myself, my heirs, assigns, and next of kin, I release and agree to indemnify the RELEASEES from any and all liabilities provided above,
even if arising from their negligence.

Competitors Signature
(Parent or Guardian's Signature if under 18) ________________________________________     Date ________

Emergency Phone Number(s). _________________________________________________________________