Judging/Scorekeeping Certification Test

Judging/Scorekeeping Certification Test

Participant Registration Form
I am registering for:*

Scorekeeper/TimekeeperCorner JudgeCenter JudgeInternational Judge
Select the Event Date and Location*
Event Sites
Brandywine Martial Arts [Brandywine Martial Arts Academy, LLC], 1331 Walnut Rd, Honey Brook PA 19344
Elizabethtown College, 1 Alpha Drive Elizabethtown, PA 17022
Evolution Karate Academy, Inc [Evolution Karate Academy, Inc], 735 N. Broad Street, Middletown DE 19709
Kaizen Karate Academy [Erised Investments D/B/A Kaizen Karate Academy ], 35 Commerce Way Suite 2, Dover DE 19904
Legacy Martial Arts [Legacy Martial Arts Inc], 511 Schoolhouse Rd STE 300, Kennett Square PA 19348
Nate Gordon’s Black Belt Academy [AMAT], 2231 Galloway Rd, Bensalem PA 19020
Oxford Karate Institute [BF Martial Arts LLC], 357 N 3rd Street, Oxford PA 19363
Robinsons Martial Arts Institute [Robinson’s Martial Arts Institute], 15 E. East Tioga Street, Tunkhannock PA 18657
Saucon Valley Karate Academy, 46 W. Water Street, Hellertown, PA, 18055
Summers Martial Arts [Summers Martial Arts, Personal Defense and Survival LLC], 115 N Allegheny Street, Bellefonte PA 16823
Vaughns Dojang IV-Audubon, 2808 Audubon Village Drive, Audubon PA 19403
Impact Martial Arts- 5301 Pulaski Hwy E, Perryville, MD 21903
Devine's Martial Arts -4450 Black Horse Pike, Mays Landing, NJ 08330
Participant Full Name*

First NameLast Name
Participant Adress*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant Email (Use parent email for member 17 and younger)*
example@example.com
Participant Phone Number*
Please enter a valid phone number.
Participant Birth Dates*

MonthDayYear
Date
List an Emergency Contact available during the event

Enter an emergency contact in this section. Participants 17 years and younger should include parent/guardian contact information, if relevant.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Participant Studio*
Participant Rank*
Non Region 8 Studio Name, if not listed

Region #Studio Name
Participant WTSDA #*
Signature*

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Signature Date*

MonthDayYear
Date
Guardian Signature (If Participant is 17 or younger)*

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Signature Date

MonthDayYear
Date

My Products*

Scorekeeper/Timekeeper Registration Fee

$15.00 Quantity

Judging Registration Fee

$15.00 Quantity

Total

$0.00

Credit Card

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