MICHIGAN AAU TAE KWON DO STATE CHAMPIONSHIP

MICHIGAN AAU TAE KWON DO STATE CHAMPIONSHIP Qualifying Event for 2010 AAU TKD Nationals and AAU Junior Olympics Games Sanctioned by: Amateur Athletic Union Saturday May 15 th, 2010 Mt. Pleasant High School 1155 S. Elizabeth St. Mt. Pleasant, MI. 48859 Contact Tournament Director: Grand Master Gary Eisen (Sports Director) American Warrior Martial Arts 6350 Rattle Run St. Clair, MI 48079 Phone 586-531-3304 E-Mail: miaautkdchair@yahoo.com

AAU TAEKWONDO OF MICHIGAN 2010 STATE QUALIFYING CHAMPIONSHIP MAY 14 & 15, 2010 MT. PLEASANT HIGH SCHOOL, MT. PLEASANT, MI. INFORMATION SHEET EVENT LOCATION: Mt. Pleasant High School, 1155 S. Elizabeth St., Mt. Pleasant, MI. 48859 OFFICIAL HOTELS: Fairfield Inn & Suites of Mt. Pleasant, Phone: 989-775-5000 (Host - 30 Room Block with First Come First Serve ($104.00 per night) SPECIAL AAU ROOM RATES. Please refer to AAU TKD when reserving rooms with Fairfield Inn. Room cutoff date is April 1st, 2010. Other hotels are available. Comfort Inn University Park, Phone: 989-772-4000 Hampton Inn, Phone: 989-772-5500 Super 8, 989-773-8888 CHECK-IN: Early May 14 th @ the Mt. Pleasant High School from 6:30 pm to 8:00 pm. May 15 th @ Mt. Pleasant High School from 8:30 9:00 am BLACK BELT CHECK IN ONLY!! May 15 th @ Mt. Pleasant High School from 9:00 am to 11:00 am. COMPETITION DATE: Saturday, May 15 th, 2010 QUALIFYING EVENTS: FORMS, TEAM FORMS, POINT SPARRING, OLYMPIC SPARRING ENTRY FEES: Competitors: 1-Event $50, 2-Events $60, 3-Events $70 Team Forms $40 Per Team Late registration (postmarked after May 5 th, 2010) 1 Event = $80, 2 or 3 Events = $90 ADMISSION FEES: Spectators: Adults (16 & Older)- $5 Youth (5 to 15yrs.) - $3 Under 5 - Free Coaches: $30 (Must be registered before May 14 th & show proof of Coaches Clinic Certification and have a 2 passport size photos turned in with application form & fee.) EARLY ENTRY DEADLINE: All applications must be postmarked NO LATER than May 5 th, 2010! There will be no refunds issued for any reason whatsoever!! RULES: AAU TKD RULES & REGULATIONS HANDBOOK 2010, www.aautaekwondo.org Competitors: Must have an AAU ATHLETE MEMBERSHIP. Referee/Coaches: Must have an AAU NON- ATHLETE MEMBERSHIP. Competitor/Referee or Coach: Must have ATHLETE MEMBERSHIP. UNIFORM: Coaches: Must wear Official Blue AAU Coaches shirt, white dobok uniform pants or warm up suit pants & gym shoes preferably clean white shoes. NO EXEMPTIONS! No hats, headbands, etc. will be allowed. Referees: White Dress Shirt or White Officials AAU Shirt, Black Pants and White Training Shoes / Black Sports coat and AAU tie (optional at states only). First time referees may wear dobok uniform (states only). Referees need not change to coach s attire, but still must have paid coaches fee to coach and display coaches pass while coaching. Competitors: WHITE UNIFORMS Club patches permitted (Black Collar Trim Black Belts Only) SPARRING GEAR: AWARDS: Point Sparring: Mandatory: mouth guard, full hand & foot protectors and full headgear with padded top. Males must wear a groin cup and supporter inside the uniform. Refer to AAU Handbook. Olympic Sparring: Mandatory: mouth guard, Olympic style chest protector, full headgear w/padded top, shin & instep protectors, forearm protector. Males must wear a groin cup and supporter inside the uniform. Refer to AAU handbook. Safety equipment may not be taped for any reason. Medals will be awarded to the top 4 places in each division for sparring events and top 3 places for forms. The top 8 athletes in each division will be eligible to participate in Nationals & JO s. If there is less than 8 in a division and YOU choose NOT to compete you will be given a Finalist Award instead of a medal. SPECIAL NOTE: Divisions May Be Combined Or Modified at the Discretion of the Tournament Committee!

SCHEDULE OF EVENTS: Friday May 14 th, 2010: Late & Last Registration 6:30-8:00 pm Mt. Pleasant High School Early bird Athlete s Check in 6:30-8:00 pm Mt. Pleasant High School Saturday May 15 th, 2010: NO Registration the Day of the Tournament for Coaches or Athletes, No Exceptions. Check In Black Belts ONLY 8:30-9:00 am Mt. Pleasant High School Athlete s/coaches Check In 9:00-10:30 am Mt. Pleasant High School 14 17 Black Belts & Adult Black Belt Competition: 9:00-11:00 am Mt. Pleasant High School (Forms, Point & Olympic) Referees Meeting Following Black Belt Competition at 11 a.m. Opening Ceremony 11:30 am Mt. Pleasant High School Team Forms Competition begins right after Open Ceremony Competition Begins at 12:00 Noon with STAGGING AND RING ASSIGNMENTS Order of Events: 5 yr. olds & UP (Forms/Point/Olympic) Please remember to: Fill out the registration form completely. Sign the Waiver. Enclose Money Order or Certified Check made out to Postmarked by May 5 th or late fee will apply. (If mailed out after May 5 th please include late fee automatically. If late fee is not included, late fee will be due at check-in. Do not mail out registrations after May 10 th they will not be received in time. MAIL REGISTRATIONS TO: AAU TKD OF MICHIGAN 6350 Rattle Run St. Clair, MI 48079 Questions regarding registrations, please contact Master Ann Shaw at 810-434-5780 or Email: awmatkd@yahoo.com. If CERTIFIED - MAIL REGISTRATIONS TO: AAU TKD OF MICHIGAN P.O. BOX 229 ST. CLAIR, MI 48040 MAKE MONEY ORDERS PAYABLE TO: AAU TKD OF MI QUESTIONS CONTACT: GRAND MASTER GARY EISEN PHONE: 586-531-3304 E-MAIL: miaautkdchair@yahoo.com!" # $%&'(&'))(&'*+*', SPECIAL NOTE: Divisions May Be Combined Or Modified at the Discretion of the Tournament Committee!

Mt. Pleasant High School MICHIGAN AAU TAE KWON DO STATE CHAMPIONSHIP MAY 15, 2010 Mt. Pleasant, Michigan Individual Entry Form *Early Registration must be postmarked by May 5 th, 2010* Please Print Clearly: Late Registration: postmarked after May 5 th, 2010 Last Name: First Name: Address: City: State: Zip: Phone #: - Date of Birth: / / Age (as of August 31, 2010): Competition Height: ft. inches Competition Weight: (Be Accurate, weigh-in may be requested) Competition Rank: Belt Color Gup/Dan Rank: Sex: M / F Current AAU # (mandatory): Martial Art School Affiliation: Head Instructor: School Address: City: State: Zip: School Phone # School Email Address: Check Division(s) you wish to participate (Competitors may compete in 3 Events): Forms: Point Sparring: Olympic Sparring: (Black Belt Team Must fill out Team application form) Competition Fee: 1 Event = $50, 2 Events = $60, 3 Events = $70 Late Registration: 1 Event = $80, 2 or 3 Events = $90 APPLICATIONS MUST BE RECEIVED NO LATER THAN May 5 TH OR LATE REGISTRATION FEE WILL BE ASSESSED! PLEASED DO NOT MAIL REGISTRATION AFTER MAY 10 th! Registrations WILL NOT be accepted at the door on May 9 th! THERE WILL BE NO REFUNDS ISSUED! Make certified check or money order payable to: Mail Completed Application to: Or Mail All CERTIFIED Applications to: 6350 Rattle Run P.O. Box 229 St. Clair, MI 48079 St. Clair, MI 48079 The above information is true and I fully understand that divisions may be combined or modified for competition at the discretion of the tournament committee! Competitor s/parent or Guardian s Signature:

MICHIGAN AAU TAE KWON DO STATE CHAMPIONSHIP MAY 15, 2010 Mt. Pleasant High School TEAM FORMS Entry Form *Early Registration must be post marked by May 5 th, 2010* Late Registration: postmarked after May 5 th, 2010 Entry Fee: $40 Per Team Late Fee: $50 Per Team 3-Member Team Forms ONLY!!!!!!!!!!!!!! Mt. Pleasant, Michigan AAU MEMBERSHIP: All athletes, coaches & officials must be current AAU members and be able to present a valid AAU card at check in. AGE GROUP: (circle one) SEX: (circle one) 8 17 Black Belt 18 & Up Black Belt Male Female Mixed First/Last Name Age AAU# Rank (dan) 1. 2. 3. Team Name: Team Contact: Name: Address: City: State: Zip: Phone #: Email: Please refer to the 2010 Official AAU Tae Kwon Do Handbook for information regarding: Team Make-Up Forms and order of competition. APPLICATIONS MUST BE RECEIVED NO LATER THAN May 5 TH OR LATE REGISTRATION FEE WILL BE ASSESSED! PLEASED DO NOT MAIL REGISTRATION AFTER MAY 10 th! Registrations WILL NOT be accepted at the door on May 15 th! THERE WILL BE NO REFUNDS ISSUED! Make certified check or money order payable to: : Mail Completed Application to: If Sending by Certified Mail: 6350 Rattle Run P.O. Box 229 St. Clair, MI 48079 St. Clair, MI 48079 I hereby certify that I know and understand the rules, policies, and code of conduct for AAU Tae Kwon Do. I certify that I have registered these athletes in the correct age grouping and that each has qualified to compete according to the specifications outlined in the AAU Take Kwon Do Handbook. I understand that each athlete is responsible for producing an AAU membership card at checkin/registration and that they each may have to produce a birth certificate at the competition if an athlete s age is challenged. I also understand that the team may be eliminated from the competition if I have misrepresented any of the above information. Team Contact Signature (Must be over 18) Date

MICHIGAN AAU TAE KWON DO STATE CHAMPIONSHIP MAY 15, 2010 Mt. Pleasant High School Mt. Pleasant, Michigan COACHES Registration Form (Please print clearly or type) Coaches Fee: $30 Paper Clip two (2) passport size photos with application. Any applications without photos will not be processed and coaches will not be eligible to coach at tournament. AAU MEMBERSHIP: All athletes, coaches & officials must be current AAU members and be able to present a valid AAU card & Coaches/Officials Clinic Card at check in. **All Coaches must attach a copy of 2010 Coaches Clinic Certification & 2 Passport Size Photos to application be eligible to Coach at this Event!** FIRST NAME: LAST NAME: ADDRESS: CITY: STATE: ZIP: HOME #: WORK: DATE OF BIRTH / / AGE: AAU# (Required): AAU District Name: COACHES CERTIFICATION NUMBER (required): LAST CERTIFICATION CLINIC ATTENDED: DATE: / / LOCATION: INSTRUCTOR: Tae Kwon Do School Affiliation: School Name: Email: School Address: City: State: Zip: Head Instructor: Phone #: COACHES REGISTRATIONS MUST BE RECEIVED NO LATER THAN MAY 12 th! PLEASED DO NOT MAIL REGISTRATION AFTER MAY 10 th! Make Certified Check to: AAU TKD of MI Mail Completed Application with Check to: Mail Registrations to: If Sending by Certified Mail: 6350 Rattle Run P.O. Box 229 St. Clair, MI 48079 St. Clair, MI 48079 I understand that COACHES must wear proper attired according to AAU rules. (Royal Blue AAU Coaches Shirt, white dobok pants or warm-up suit pants and white sneakers, no hats, headbands etc. will be allowed.) And in order to be on the floor, I MUST have taken a Coaches Clinic Online or in person prior to this event and wear my coaches certification with photo badge clearly visible on the outside of my blue shirt. Signature: ALL REFEREES MUST BRING THEIR CLINIC PARTICIAPATION CARD TO THE TOURNAMENT!

MICHIGAN AAU TAE KWON DO STATE CHAMPIONSHIP MAY 15, 2010 Mt. Pleasant High School Mt. Pleasant, Michigan OFFICIALS Application/Registration Form (Please print clearly or type) AAU MEMBERSHIP: All athletes, coaches & officials must be current AAU members and be able to present a valid AAU card & Coaches/Officials Clinic Card at check in. **All Officials must attend a 2010 Officials Clinic to be eligible to Officiate at this Event!** FIRST NAME: LAST NAME: ADDRESS: CITY: STATE: ZIP: HOME #: WORK: RANK: DATE OF BIRTH / / AGE: AAU# (Required): AAU District Name: OFFICIALS CERTIFICATION NUMBER (required): OFFICIALS CERTIFICATION CLASS (circle one): AA A B C D E LAST CERTIFICATION CLINIC ATTENDED: DATE: / / LOCATION: INSTRUCTOR: Tae Kwon Do School Affiliation: School Name: Email: School Address: City: State: Zip: Head Instructor: Phone #: PLEASE MAIL BEFORE MAY 10 th. AFTER MAY 10 ST, PLEASE CONTACT TOURNAMENT DIRECTOR REGARDING OFFICIATING FAX Mail Completed Application to: If Sending by Certified Mail: 6350 Rattle Run P.O. Box 229 St. Clair, MI 48079 St. Clair, MI 48079 I understand that officials must be properly attired according to AAU rules. I further understand that in order to receive certification, and/or upgrade, as well as work the event, that I must attend an Officials clinic at the local District or Regional level in 2010 prior to the date of this event. I also understand that an upgrade in certification will be contingent solely upon my performance. Signature: **To keep all rings running, WE ask that Officials choose to Officiate or Coach at the tournament, not both. Officials that want to coach & officiate will have to pay the coaches fee. **To receive a stipend, officials must correctly fill out this registration form prior to the tournament.

MICHIGAN AAU TAE KWON DO STATE CHAMPIONSHIP ATHLETE/COACH/REFEREE WAIVER/RELEASE FORM (AGREEMENT) IN CONSIDERATION of being permitted to participate in any way in any Amateur Athletic Union of the U.S., Inc., activity (Tae Kwon Do) I, for myself, my personal representatives, assigns, heirs and next of kin. 1. ACKNOWLEDGE, agree and represent that I understand the nature of the activity and that I am qualified, in good health and in proper physical condition to participate in such an activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. FULLY UNDERSTAND that (a) ATHLETIC ACTIVITIES INVOLVE RISK AND DANGERS OF SERIOUS BODILY INJURY INCLUDING PERMANENT DISABILITY. PARALYSIS AND DEATH (RISKS), (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Tournament, the condition in which the tournament takes place, or THE NEGLIGENCE OF THE RELEASES NAMED BELOW, there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either known to me or not readily foreseeable at this time, and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND RESPONSIBILITY FOR LOSSES, COST AND DAMAGES I incur as a result of my participation or that of the minor in the tournament. 3. HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE the Amateur Athletic Union of the U.S. Inc. (AAU) Mt. Pleasant School District, including its representatives, the related affiliated and subsidiary companies, as well as the officers, directors, agents, employees and assigns of each, and the AAU s Associations, clubs, coaches, officials, administrators, members, volunteers, participants, sponsors, advertisers, and if applicable, owners and lessors of premises on which the tournament takes place, and any other indemnified and held harmless by the AAU, each considered on the RELEASES herein FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NIGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, NEGLIGENT SECURITY, TRAVEL, AND RECREARTIONAL OPERATIONS AND ACTIVITIES; AND I FURTHER AGREE that if, despite this RELEASE AND VAIVER, ASSUMPTION OF RISK, AND HARMLESS EACH OF THE RELEASES from any litigation expenses, attorney fees, loss, liability, damages, or any cost which any may incur as the result of such claim. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLEETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT BALANCE, NOT WITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. Print Name of Participant: Date: Participant s Signature (only if age 18 or OVER): MINOR RELEASE AND I, THE MINOR S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF ATHLETIC ACTIVITIES AND THE MINOR S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, CONVENANT NOT TO SUE, AND AGREE TO INDEMINIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE S FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE S OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATION AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I THE MINOR OR ANYONE ON THE MINOR S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEE S NAMED ABOVE, I WILL INDMINIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEE S FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS OF LIABILITY, DAMAGE OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM. PARENT/GUARDIAN SIGNATURE: (Only if participant is under the age of 18).