En blanco

1st Matsushima Cup

Underneath you can find:

· Information about the event's itinerary and transportation

· Fighters enrolment application form

· Conditions for participation.

· Doctor's Report Form

· IKO MATSUSHIMA´s corner judges and referees Information

· Accommodation details

Cuadro de texto: Federation Kyokushin Karate Matsushima Poland Branch Chief and Country Representative: Sensei Roman Kucfir 26-500 Szydlowiec ul. Kolejowa 71-A. Tel/fax: 48 48 617 54 45. Email: rkucfir@poczta.onet.pl

Enrolment application form

Applicant's Personal Details: (please print neatly or type)

Family Name: _________________________________ Given Name: _____________________________________________

Address: _______________________________________________________________________________________________

Area code: ________________ Telephone: Home _______________________ Email address: __________________________

Date of Birth: _____ / _____ /_____ Age at 5th November 2005. ______ Years. Grade: ______________________

Instructor: ________________________________________ Dojo (club) _________________________________

Martial art practised: _____________________________________________________________________________________

Divisions: It is the applicant's responsibility to ensure that they enter correct divisions relating to gender and weight. Please tick the weight division you wish to enter. ?

____ Male Lightweight 70kg & under ____ Female Lightweight 60kg & under.

____ Male Middleweight 80k kg & under

____ Male Heavyweight 90 kg & under ____ Female Heavyweight over 60 kg

____ Male Super heavyweight over 90 kg

Groin guards are compulsory for all male competitors. For women breast protectors that leaves the complete area of the chudan (solar plexus) open (unprotected) must be used.

FIRST AID: By signing this application the applicant also gives his/her consent to receive medical treatment, which may be deemed (which will be of first aide type only) advisable in the event of injury, accident or illness sustained by the applicant during the said tournament.

Medical declaration.

By signing this application the applicant hereby assumes full ant total responsibility for his/her safety and personal possessions and the applicant releases the tournament organizers, agents, sponsors and other competitors from any liability, for any injury or personal loss of any kind whatsoever. The applicant acknowledges that he/she understand the risks associated with competing in this kind of karate tournament.

Doctors’ report.

The fighter has no history of: epilepsy, major head injury, cranial head injury.

The fighter has not suffered from head trauma resulted in loss consciousness in the last month.

The fighter has not suffered fracture of bone in the foot, leg, hand, arm, chest, face or scull in the last 2 months.

The fighter does not take an anticoagulant or anti epileptic medication.

Doctors (name) ____________________________________________________________________________________________

Address: _________________________________________________________________________________________________

Phone: __________________________________ Fax: ________________________________________

The fighter is fit to compete in full contact karate bout: _______ Not fit: _______ (please tick one)

Doctors’ signature: ________________________________________________________________________________________

Competitors’ code of ethics:

Should my entry in to this event be accepted I hereby declare that I will, at all times compete to the best of my abilities, obey the rules of tournament, obey the referee, display good sportsmanship and courtesy.

Entry fee: 10 Euro (paid upon arrival)

Deadline: Entries are accepted by: regular mail Fax or email. All applications must arrived at the above address on or before:

31^st day of July 2005.

Signature of applicant (fighter):

_______________________________________________________________________________

Iko Matsushima

Referees and Judges

Referees:

Full name: _______________________________________________________________________ Rank: ________ Dan.

Corner Judges:

Full name: _______________________________________________________________________ Rank: ________ Dan.