27th Georgia State Open
There are 2 parts to this form, the registration section and the payment section on next page to make your payment via the PayPal.
Competitor Information
Name: Male/Female: Email Address:
Competitor's name is required. Please select the Competitor's sex. Competitor's email is required.Invalid format.
Address: City: State:  Zip Code:
Competitor's Address is required. Competitor's City is required. Competitor's State is required.   Competitor's Zip Code is required. Invalid format.
Age:  DOB (MM/DD/YY): Telephone # (404) 555-1212: Rank:
Competitor's Age is required.    Competitor's Date of Birth is required. Competitor's Telephone Number is required.Invalid format. (404) 555-1212 Please select the Competitor's Rank.
Karate School Information
Karate School: Instructor: School Telephone # (404) 555-1212:
Competitor's Karate School is required. Competitor's Instructor is required. Competitor's Karate School Telephone Number is required.Invalid format. (404) 555-1212
Address: City: State:  Zip Code:
Competitor's Karate School Address is required. Competitor's Karate School City is required. Competitor's Karate School State is required.   Competitor's Karate School Zip Code is required.Invalid format.
Youth Black Belt Divisions
Youth Forms: Youth Weapons: Youth Sparring:
Youth Musical Forms: Youth Musical Weapons:
Adult Black Belt Divisions
Adult Forms: Adult Weapons: Adult Sparring:
Adult Musical Forms: Adult Musical Weapons:
Youth Under Belt Divisions
Youth Forms: Youth Weapons:
Youth Sparring Boys & Girls: Youth Sparring Boys: Youth Sparring Girls:
Youth Musical Forms: Youth Musical Weapons:
Adult Under Belt Divisions
Men's Forms: Women's Forms: Adult Weapons:
Men Sparring: Women Sparring:
Adult Musical Forms: Adult Musical Weapons:
Specialty Divisions
Self Defense: Breaking: Team Fighting:
Team Forms: Handicap: Continuous Fighting:
Jiu-Jitsu:
Spectator & Coach Passes
Spectator Pass(s): Coach Pass(s):
Payment Information
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Date (Read Only):
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