Registration

CAPITAL CHALLENGE INTERNATIONAL
Amman - Jordan 19th & 20th December 2008

Participant Registration Form

Registering for the Capital Challenge tournament is easy, simply follow the steps below:

Step 1. Complete the online form below and press 'Submit'.

Step 2. Click on the 'PayPal' button to pay the $30 registration fee*.

* To complete the registration, please have a credit card or a PayPal account ready. This is a secure payment via PayPal.

Please note that both steps must be complete for the registration to be valid.

• Deadline is December 16th, 2008 (11:59 pm GMT) - No registration forms will be accepted after this date

Participant's Information

First Name: *

Last Name: *

Date of Birth: *

Telephone Number: *

Email: *

Registration Date:

Participant's Address

Street:

City: *

State/Province:

Country: *

Academy Address

Street: *

City: *

State/Province:

Country: *

Telephone Number: *

Academy Information

Academy Name: *

Instructors Name: *

Participant's Division

Gender: *

Belt Division: *

Weight Division: *

Do you intend to complete in the open weight class: *

Yes

Emergency Contact

Name: *

Telephone: *

Waiver:

I the undersigned, do hereby submit my application for participation in the Capital Challenge International December 2008 held at the Orthodox Club, Amman, Jordan on Friday and Saturday, December 19th and 20th, 2008. I hereby assume full responsibility and liability for all damages, injuries and losses that I may sustain or incur while participating in or watching the tournament.
I realize that serious injury is commonplace in martial arts tournaments such as the one I am hereby entering and that death is a possibility. I also realize that if I am injured, I might be disfigured, disabled and/or rendered unable to work again. By entering into this competition I agree to and fully accept and assume liability for any and all injuries that I may incur expressly give up and waive any and all claims that I or anyone acting on my behalf or through me might have against Jordanian Brazilian Jiu-Jitsu Federation (JBJJF), Jordan Combat Consulting Co., Confederacao Brasileira de Jiu-Jitsu (CBJJ), International Brazilian Jiu-Jitsu Federation (IBJJF), Zaid Mirza, the promoters, operators, sponsors, officials, participants, non-participants, or the Orthodox Club and their agents, employees and representatives for any injury regardless of its nature, effect or affect on me as a result of my participation and/or presence at the tournament.
I authorize, and agree to hold harmless, whatever medical personnel that may be present at the tournament to take any action necessary, should I become injured.
I further understand that tickets will be sold to spectators to watch the tournament; that news media and others might cover the tournament and that it may also be videotaped or otherwise shown to audiences around the world. I hereby expressly and irrevocably forever consent to having my likeness shown, publicized, commented and/or reported on; and I do not expect to, and in fact waive any compensation I might otherwise be entitled to as a result thereof.
I represent that I am in good health; that I am not presently, nor will I participate while under the influence of any drug or medication.
Organizer expressly reserves the right, in its sole and absolute discretion, with or without cause, to add or remove an athlete from the open weight division.
The JBJJF and Jordan Combat Consulting Co.(Organizer) hereby expressly reserves the right, in its sole and absolute discretion, with or without cause to deny a potential athlete/competitor's registration/application for permission to compete in the event. The terms athlete and/or competitor may be used interchangeably.

I accept: *

Yes

In case of minors under 18 years old:

I accept on behave of the participant:

Yes

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