Individual Registration Form

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1 Organized by Hosted by Organized by Individual Registration Form 2nd All- America Taijiquan Cup 2014 U.S. Traditional Team Trials July 26 and 27, 2014 At Manchester High School 134 E. Middle Turnpike Manchester, Connecticut FIRST DEADLINE (LATE FEES AFTER THIS DATE): June 20 FINAL DEADLINE (NO REGISTRATIONS ACCEPTED AFTER THIS DATE): July 1 PLEASE PRINT OR TYPE LAST NAME: FIRST: MI: STREET: CITY: STATE: ZIP: PHONE (PRIMARY): PHONE (ALTERNATE): DATE OF BIRTH: M / D / Y AGE: SEX (CIRCLE ONE): M F YEARS EXPERIENCE: SCHOOL: PRIMARY INSTRUCTOR: SCHOOL ADDRESS: CITY: STATE: ZIP: PHONE: FAX: WAIVER I, the undersigned, knowingly and without duress, do voluntarily submit my entry to the, the 5 th New England International Wushu Championships, and the 2014 All- America Taijiquan Cup (hereinafter referred to collectively as the Championships ). I hereby assume all risk of physical and mental injuries, disabilities, and losses which may result from or in connection with my participation in the Championships. Hereinafter the USA Wushu- Kungfu Federation, USA National Tai Chi Chuan Federation, Malee s School of Tai Chi & Kung Fu, and Manchester High School are collectively referred to as the Organizing Committee. Acting for myself, my heirs, personal representatives and assignees, I do hereby release the Organizing Committee, its officers, agents, representatives, servants, employees, volunteers, and all other members from liability due to any injuries incurred and any resulting legal claims, actions, suits or controversies. I also understand that there is risk of injury involved in all the competitive divisions, particularly in fighting events, and I assume full responsibility for all my actions, activities or omissions during and in connection with the Championships. I fully understand that any medical attention or treatment afforded me by the Organizing Committee, its officers, agents, representatives, servants, employees, volunteers, and all other related members will be of the first aid type only, and I hereby release the Organizing Committee, its officers, agents, representatives, servants, employees, volunteers, and all other related members from any liability for such aid. I have read, understand, and agree to abide by the rules of this event, and accept all responsibility and associated liability for infringement of such rules. Additionally, I am fully aware of my personal medical condition and hereby certify that I am mentally and physically fit to compete. I consent to the use of photographs and/or video recordings of my participation in this event for promotional purposes, and hereby waive my rights to any form of compensation or claim. Parent or legal guardian signature is required if participant is under eighteen (18) years of age Signature of Participant Signature of Legal Guardian Date Please mail this form to: USA National Tai Chi Chuan Federation, 249 Broad St, Manchester, CT Contact: Phone (860) taijiquantrials@gmail.com You may make copies of this form for personal use You may also register online through our website.

2 Page 2 of 5 FEES PLEASE FILL OUT CAREFULLY! (1) 2014 U.S. TAIJIQUAN TEAM TRIALS FEES Basic Registration Fee: $120 Each event: $30 x events USAWKF membership no. (REQUIRED): $30 late fee (after June 20) (2) 5 th New England INTERNATIONAL WUSHU CHAMPIONSHIPS FEES Basic Registration Fee: $90 Each event: $20 x events USAWKF membership discount: $5 USAWKF membership no.: USANTCCF membership discount: $5 USANTCCF membership no.: Traditional Team Trials: $50 Grand Champion Trophy Trial: $35 $20 late fee (after June 20) (3) 2014 ALL- AMERICA TAIJIQUAN CUP Basic Registration Fee: $100 Each event: $25 x events USAWKF membership discount: $5 USAWKF membership no.: USANTCCF membership discount: $5 USANTCCF membership no.: $25 late fee (after June 20) (4) SPECTATOR TICKETS Saturday Tickets: (does NOT include Masters Demo) $10 x people Sunday Tickets: $10 x people Masters Demo (Saturday, 8 pm) $20 x people Both Days plus Master Demo: $30 $30 x people (5) TOTALS FOR (1) THROUGH (4) Each competitor will receive ONE complimentary ticket (for family/friends/etc.) for Saturday and Sunday competitions as well as the Masters Demo. (1) Taijiquan Team Trials Fees (2) N.E. Int l Championships Fees (3) All- America Cup (4) Spectator Tickets Fees PLEASE NOTE: There will be a $30 charge for each event change after your initial registration is accepted. Payment with Check: Please make checks payable to USA National Tai Chi Chuan Federation and mail to 249 Broad Street, Manchester, CT Payment with credit card: Cardholder name: Street address: City: State: Zip: Card number: Exp (MM/YY): / CVV number: This event will select competitors who will represent the U.S. at the 1 st World Taijiquan Championships, to be held November 1-4, 2014, in Chengdu, China. (U.S. citizens only) This event is an open competition for Chinese martial arts practitioners of all styles, ages, and experience levels. This event will award a spot on the 2014 U.S. Traditional Team for any competitor who finishes third in any traditional event. The U.S. team will go on to compete at the 6th World Traditional Wushu Championships in Chizhou, China, October 23-29, This is a chance for competitors to go home with a beautiful trophy in recognition of their outstanding achievement at the event. The athlete with the best results in at least three events in their age group will win a Grand Champion Trophy, provided he or she signs up for the Trophy event and competes in at least three events, including at least one weapon and one barehand. This is a Grand Champion event for advanced taijiquan competitors. The competition is divided into 3 age groups, with first, second, and third place trophies for each age group, male and female. Champions will be chosen by their combined highest barehand score and highest weapon score. (U.S. citizens and permanent residents only)

3 Page 3 of U.S. TAIJIQUAN TEAM TRIALS REGISTRATION U.S. citizens only must be current member of USAWKF Please make a check mark ( ) next to the age group you are registering in, and then make a check mark in the space provided for each event you are competing in. Registration fee (REQUIRED): [ ] $120. Events: $30 x events =. I. Competition Events (at least one barehand and one weapon required): Age: [ ] [ ] Optional Taijiquan [ ] Optional Taijijian [ ] Compulsory Yang Style Taijiquan [ ] Compulsory Yang Style Taijijian [ ] Compulsory Chen Style Taijiquan [ ] Compulsory Chen Style Taijijian [ ] Compulsory 36 Form Taijjiquan (3 rd Set Competition Routine) [ ] Compulsory 39 Form Taijijian (3 rd Set Competition Routine) II. Demonstration Events (at least one barehand and one weapon required): Age: [ ] [ ] [ ] 24 Form Taijiquan [ ] 42 Form Taijiquan [ ] Yang Style Competition Routine [ ] Chen Style Competition Routine [ ] 32 Form Taijijian [ ] 42 Form Taijijian [ ] Trad. Yang Style Taijiquan [ ] Trad. Yang Style Taijijian [ ] Trad. Chen Style Taijiquan [ ] Trad. Chen Style Taijijian [ ] Trad. Wu Style Taijiquan [ ] Trad. Wu Style Taijijian [ ] Trad. Sun Style Taijiquan [ ] Trad. Sun Style Taijijian III. Group competition registration for the Trials is in the Group Registration Form.

4 Page 4 of 5 5 th NEW ENGLAND INTERNATIONAL WUSHU CHAMPIONSHIPS REGISTRATION Experience Levels Beginner, 0-2 years Intermediate, 2-4 years Advanced, 4+ years You may register in only one experience level for all external events, one for all internal events, and one for all contact events At the sole discretion of the Organizing Committee, events and divisions may be combined or divided at any time prior to competition. nt A. Youth External Events 100. Traditional Kung Fu - Barehand [ ] 101. Children 6 & under, beginner [ ] 102. Children 6 & under, int- adv [ ] 103. Children 7-9, beginner [ ] 104. Children 7-9, int- adv [ ] 105. Children 10-12, beginner [ ] 106. Children 10-12, int- adv [ ] 107. Children 13-15, beginner [ ] 108. Children 13-15, int- adv [ ] 109. Teen boys, 16-18, beginner [ ] 110. Teen boys, 16-18, int- adv [ ] 111. Teen girls, 16-18, beginner [ ] 112. Teen girls, 16-18, int- adv 200. Traditional Kung Fu Weapons [ ] 201. Children 6 & under, beginner [ ] 202. Children 6 & under, int- adv [ ] 203. Children 7-9, beginner [ ] 204. Children 7-9, int- adv [ ] 205. Children 10-12, beginner [ ] 206. Children 10-12, int- adv [ ] 207. Children 13-15, short/other, beginner [ ] 208. Children 13-15, short/other, int- adv [ ] 209. Children 13-15, long, beginner [ ] 210. Children 13-15, long, int- adv [ ] 211. Teen boys, 16-18, short/other, beginner [ ] 212. Teen boys, 16-18, short/other, int- adv [ ] 213. Teen boys, 16-18, long, beginner [ ] 214. Teen boys, 16-18, long, int- adv [ ] 215. Teen girls, short/other, beginner [ ] 216. Teen girls, 16-18, short/other, int- adv [ ] 217. Teen girls, 16-18, long, beginner [ ] 218. Teen girls, 16-18, long, int- adv 300. Contemporary Wushu - Barehand [ ] 301. Children 6 & under, beginner [ ] 302. Children 6 & under, int- adv [ ] 303. Children 7-9, beginner [ ] 304. Children 7-9, int- adv [ ] 305. Children 10-12, beginner [ ] 306. Children 10-12, int- adv [ ] 307. Children 13-15, beginner [ ] 308. Children 13-15, int- adv [ ] 309. Teen boys, 16-18, beginner [ ] 310. Teen boys, 16-18, intermediate [ ] 311. Teen boys, 16-18, changquan, advanced [ ] 312. Teen boys, 16-18, nanquan, advanced [ ] 313. Teen boys, 16-18, other, advanced [ ] 314. Teen girls, 16-18, beginner [ ] 315. Teen girls, 16-18, intermediate [ ] 316. Teen girls, 16-18, changquan, advanced [ ] 317. Teen girls, 16-18, nanquan, advanced [ ] 318. Teen girls, 16-18, other, advanced 400. Contemporary Wushu - Weapons [ ] 401. Children 9 & under, beginner [ ] 402. Children 9 & under, int- adv [ ] 403. Children 10-12, short/other, beginner [ ] 404. Children 10-12, short/other, int- adv [ ] 405. Children 10-12, long, beginner [ ] 406. Children 10-12, long, int- adv [ ] 407. Children 13-15, short/other, beginner [ ] 408. Children 13-15, short/other, int- adv [ ] 409. Children 13-15, long, beginner [ ] 410. Children 13-15, long, int- adv [ ] 411. Teen boys, 16-18, broadsword, beg [ ] 412. Teen boys, 16-18, broadsword, int- adv [ ] 413. Teen boys, 16-18, str. sword, beg [ ] 414. Teen boys, 16-18, str. sword, int- adv [ ] 415. Teen boys, 16-18, staff, beginner 400. Contemporary Wushu Weapons (cont.) [ ] 416. Teen boys, 16-18, staff, int- adv [ ] 417. Teen boys, 16-18, spear, beginner [ ] 418. Teen boys, 16-18, spear, int- adv [ ] 419. Teen girls, 16-18, broadsword, beg [ ] 420. Teen girls, 16-18, broadsword, int- adv [ ] 421. Teen girls, 16-18, str. sword, beg [ ] 422. Teen girls, 16-18, str. sword, int- adv [ ] 423. Teen girls, 16-18, staff, beginner [ ] 424. Teen girls, 16-18, staff, int- adv [ ] 425. Teen girls, 16-18, spear, beginner [ ] 426. Teen girls, 16-18, spear, int- adv B. Adult External Events 500. Traditional Kung Fu Barehand [ ] 501. Men s, 18-35, Northern, beginner [ ] 502. Men s, 18-35, Southern, beginner [ ] 503. Men s, 18-35, Northern, intermediate [ ] 504. Men s, 18-35, Southern, intermediate [ ] 505. Men s, 18-35, Northern, advanced [ ] 506. Men s, 18-35, Southern, advanced [ ] 507. Men s, 36+, All Styles, beginner [ ] 508. Men s,36+, All Styles, int- adv [ ] 509. Women s 18-35, Northern, beginner [ ] 510. Women s 18-35, Southern, beginner [ ] 511. Women s 18-35, Northern, int [ ] 512. Women s 18-35, Southern, int [ ] 513. Women s 18-35, Northern, advanced [ ] 514. Women s 18-35, Southern, advanced [ ] 515. Women s, 36+, All Styles, beginner [ ] 516. Women s, 36+, All Styles, int- adv 600. Traditional Kung Fu Weapons [ ] 601. Men s, 18-35, short/other, beginner [ ] 602. Men s, 18-35, long, beginner [ ] 603. Men s, 18-35, short/other, int [ ] 604. Men s, 18-35, long, intermediate [ ] 605. Men s, 18-35, short, advanced [ ] 606. Men s, 18-35, long, advanced [ ] 607. Men s, 36+, All Weapons, beginner [ ] 608, Men s, 36+, All Weapons, int- adv [ ] 509. Women s, 18-35, short/other, beginner [ ] 610. Women s, 18-35, long, beginner [ ] 611. Women s, 18-35, short/other, int [ ] 612. Women s, 18-35, long, intermediate [ ] 613. Women s, 18-35, short, advanced [ ] 614. Women s, 18-35, long, advanced [ ] 615. Women s, 36+, All Weapons, beginner [ ] 616. Women s, 36+, All Weapons, int- adv 700. Contemporary Wushu Barehand [ ] 701. Men s, 18+, beginner [ ] 702. Men s, 18+, changquan/other, int [ ] 703. Men s, 18+, nanquan, intermediate [ ] 704. Men s, 18+, changquan, advanced [ ] 705. Men s, 18+, nanquan, advanced [ ] 706. Men s, 18+, other, advanced [ ] 707. Women s, 18+, beginner [ ] 708. Women s, 18+, changquan/other, int [ ] 709. Women s, 18+, nanquan, intermediate [ ] 710. Women s, 18+, changquan, advanced [ ] 711. Women s, 18+, nanquan, advanced [ ] 712. Women s, 18+, other, advanced 800. Contemporary Wushu Weapons [ ] 801. Men s, 18+, All Weapons, beginner [ ] 802. Men s, 18+, short/other, intermediate 800. Contemporary Wushu Weapons (cont.) [ ] 803. Men s, 18+, long, intermediate [ ] 804. Men s, 18+, short, advanced [ ] 805. Men s, 18+, long, advanced [ ] 806. Men s, 18+, other, advanced [ ] 807. Women s, 18+, beginner [ ] 808. Women s, 18+, short/other, intermediate [ ] 809. Women s, 18+, long, intermediate [ ] 810. Women s, 18+, short, advanced [ ] 811. Women s, 18+, long, advanced [ ] 812. Women s 18+, other, advanced C. Internal Events 900. Taijiquan [ ] 901. Men s, 45 & under, all styles, beginner [ ] 902. Men s, 45 & under, all styles, intermediate [ ] Men s, 45 & under, 42 Form Taijiquan, adv [ ] 903. Men s, 45 & under, Yang style, advanced [ ] 904. Men s, 45 & under, Chen style, advanced [ ] 905. Men s, 45 & under, Wu style, advanced [ ] 906. Men s, 45 & under, Wu/Hao style, adv [ ] 907. Men s, 45 & under, Sun style, advanced [ ] Men s, 45 & under, Zhaobao style, advanced [ ] 908. Men s, 45 & under, Other styles, advanced [ ] 909. Women s, 45 & under, all styles, beginner [ ] 910. Women s, 45 & under, all styles, int [ ] Women s, 45 & under, 42 Form Taiji, adv [ ] 911. Women s, 45 & under, Yang style, adv [ ] 912. Women s, 45 & under, Chen style, adv [ ] 913. Women s, 45 & under, Wu style, advanced [ ] 914. Women s, 45 & under, Wu/Hao style, adv [ ] 915. Women s, 45 & under, Sun style, advanced [ ] Women s, 45 & under, Zhaobao style, adv [ ] 916. Women s, 45 & under, Other styles, adv [ ] 917. Men s/women s, 46-65, all styles, beginner [ ] 918. Men s/women s, 46-65, all styles, int- adv [ ] 919. Men s/women s, 66+, all styles, beginner [ ] 920. Men s/women s, 66+, all styles, int- adv Other Internal Barehand [ ] Men s/women s 45 & under, All other, beg [ ] Men s/women s 45 & under, Bagua, int [ ] Men s/women s 45 & under, Xingyi, int [ ] Men s/women s 45 & under, Other, int [ ] Men s 45 & under, Baguazhang, advanced [ ] Men s 45 & under, Xingyiquan, advanced [ ] Men s 45 & under, Other, advanced [ ] Women s 45 & under, Baguazhang, adv [ ] Women s 45 & under, Xingyiquan, adv [ ] Women s 45 & under, Other, advanced [ ] Men s/women s 46+, All other, beginner [ ] Men s/women s 46+, All other, int [ ] Men s/women s 46+, All other, advanced Internal Weapons [ ] Men s/women s, 60 & under, Taiji sword, beg [ ] Men s/women s, 60 & under, Other, beg [ ] Men s/women s, 60 & under, 42 Taiji sword, int- adv [ ] Men s/women s, 60 & under, Taiji sword, int- adv [ ] Men s/women s, 60 & under, Other short, int- adv [ ] Men s/women s, 60 & under, Long, int- adv [ ] Men s/women s, 61+, Taiji sword, beg [ ] Men s/women s, 61+, Other, beg [ ] Men s/women s, 61+, 42 Form Taiji sword, int- adv [ ] Men s/women s, 61+, Taiji sword, int- adv [ ] Men s/women s, 61+, Other short, int- adv [ ] Men s/women s, 61+, Long, int- adv

5 Page 5 of 5 5 th NEW ENGLAND INTERNATIONAL WUSHU CHAMPIONSHIPS REGISTRATION (CONTINUED) Experience Levels Beginner, 0-2 years Intermediate, 2-4 years Advanced, 4+ years You may register in only one experience level for all external events, one for all internal events, and one for all contact events At the sole discretion of the Organizing Committee, events and divisions may be combined or divided at any time prior to competition. D. Contact Events Push Hands Restricted Step [ ] Men s 45 & under, lbs., beginner [ ] Men s 45 & under, lbs., int- adv [ ] Men s 45 & under, 161+ lbs., beginner [ ] Men s 45 & under, 161+ lbs., int- adv [ ] Men s 46+, lbs., beginner [ ] Men s 46+, lbs., int- adv [ ] Men s 46+, 161+ lbs., beginner [ ] Men s 46+, 161+ lbs., int- adv [ ] Women s 45 & under, lbs., beg [ ] Women s 45 & under, lbs., int- adv [ ] Women s 45 & under, 131+ lbs., beginner [ ] Women s 45 & under, 131+ lbs., int- adv [ ] Women s 46+, lbs., beginner [ ] Women s 46+, lbs., int- adv [ ] Women s 46+, 131+ lbs., beginner [ ] Women s 46+, 131+ lbs., int- adv Push Hands Moving Step [ ] Men s 45 & under, lbs., beginner [ ] Men s 45 & under, lbs., int- adv [ ] Men s 45 & under, 161+ lbs., beginner [ ] Men s 45 & under, 161+ lbs., int- adv [ ] Men s 46+, lbs., beginner [ ] Men s 46+, lbs., int- adv [ ] Men s 46+, 161+ lbs., beginner [ ] Men s 46+, 161+ lbs., int- adv [ ] Women s 45 & under, lbs., beg [ ] Women s 45 & under, lbs., int- adv [ ] Women s 45 & under, 131+ lbs., beg [ ] Women s 45 & under, 131+ lbs., int- adv [ ] Women s 46+, lbs., beginner [ ] Women s 46+, lbs., int- adv [ ] Women s 46+, 131+ lbs., beginner [ ] Women s 46+, 131+ lbs., int- adv Continuous Light Contact Sparring Youth [ ] Children, 8 & under, beginner [ ] Children, 8 & under, int- adv [ ] Children, 9-11, beginner [ ] Children, 9-11, int- adv [ ] Children, 12-14, beginner [ ] Children, 12-14, int- adv [ ] Teen Boys, 15-17, lbs., beginner [ ] Teen Boys, 15-17, lbs., int- adv [ ] Teen Boys, 15-17, 146+ lbs., beginner [ ] Teen Boys, 15-17, 146+ lbs., int- adv [ ] Teen Girls, 15-17, lbs., beginner [ ] Teen Girls, 15-17, lbs., int- adv [ ] Teen Girls, 15-17, 121+ lbs., beginner [ ] Teen Girls, , 21+ lbs., int- adv Continuous Light Contact Sparring Adult [ ] Men s, lbs., beginner [ ] Men s, lbs., int- adv [ ] Men s, 161+ lbs., beginner [ ] Men s, 161+ lbs., int- adv [ ] Women s, lbs., beginner [ ] Women s, lbs., int- adv [ ] Women s, 131+ lbs., beginner [ ] Women s, 131+ lbs., int- adv 2014 ALL- AMERICA TAIJIQUAN CUP REGISTRATION Experience Levels Advanced Only At least one barehand and one weapon form required At the sole discretion of the Organizing Committee, events and divisions may be combined or divided at any time prior to competition. A. Contact Events Ages 35 and under. [ ] Form Taijiquan [ ] Form Taijijian [ ] Yang Style Taijiquan [ ] Chen Style Taijiquan [ ] Wu Style Taijiquan [ ] Wu/Hao Style Taijiquan [ ] Other Styles Taijiquan [ ] Sun Style Taijijquan [ ] Zhaobao Taijiquan [ ] Yang Style Taijijian [ ] Chen Style Taijijian [ ] Other Styles Taijijian [ ] Other Short Weapon [ ] Long Weapon Ages [ ] Form Taijiquan [ ] Form Taijijian [ ] Yang Style Taijiquan [ ] Chen Style Taijiquan [ ] Wu Style Taijiquan [ ] Wu/Hao Style Taijiquan [ ] Sun Style Taijijquan [ ] Zhaobao Taijiquan [ ] Other Styles Taijiquan [ ] Yang Style Taijijian [ ] Chen Style Taijijian [ ] Other Styles Taijijian [ ] Other Short Weapon [ ] Long Weapon Ages 61+ [ ] Form Taijiquan [ ] Form Taijijian [ ] Yang Style Taijiquan [ ] Chen Style Taijiquan [ ] Wu Style Taijiquan [ ] Wu/Hao Style Taijiquan [ ] Sun Style Taijijquan [ ] Zhaobao Taijiquan [ ] Other Styles Taijiquan [ ] Yang Style Taijijian [ ] Chen Style Taijijian [ ] Other Styles Taijijian [ ] Other Short Weapon [ ] Long Weapon