WSMX Logo
World Hi-Ya Challenge Day
Boardman Address

  

   Official Application
         
Martial arts experience is not required.  R
egister each individual, location, and event seperately.

Must Register Online.   No Refunds For Any Reason

Certificate Order: Please use this Form              Registration Type (Please Select):
Individual ($19 Fee) Organization, Volunteer or Group ($89 Fee)
Hi-Ya® Competition ($45 Fee)
Division # Please Check Event Division Chart
Donation / Descritiption:
Sponsorship / Description:

 How many people Event Location

Address City State Zip
Country
  


Event Date and Time
Describe the event:


Describe youself/Group:
Representing: Town, City, County, Region, Country,
Your local News papers: Name, website, email:


WorldSMX Membership ID Number:
           
Registration Membership(Please Select):
Individual ($25/year)
Group/Organization/Business/($49/year each location)
Individual Lifetime ($1,000/person) 
Master Individual Lifetime ($3,000/person)


Applicant  

First Name / Last Name
  Gender (M/F)    Date of Birth / / / Age
Home phone Cell Phone

Address City State Zip
Country Email

Martial Arts Style Rank   How long Yrs Month,
Describe

Employed by Present position
Work phone Website

Emergency Contact Relation Phone Cell Email

 Please upload 2 photos(1 ID + 1 photo with formal dress)  and a 2 minute of competition performance video of yourself or team. 
     

Parents / Guardian of Minor Contestant (Ages under18)                  Relation   

Name Gender (M / F) , Date of Birth / /
Age
Home phone Cell

Address City State Zip
Country Email


Academic School Grade
phone email
Address City State Zip
Website

Teacher phone Cell
Email


Martial Arts School: phone
Email

Martial arts experience is not required. You may visit WSMX website: www.worldSMX.com for a listing of Martial Arts Schools.
The WSMX listing of a school is not an endorsement of the training or the facility. Contestants’ own decision and risk for training.

Address City State Zip

Country Website

   

Instructor: Title Name Rank
           Style

Phone Cell Email


Business / Organization: Phone
Email
Website
Address City State Zip
Country
Contact Person: Title Name
Phone Cell Email
Other Purchases
Item Quantity:

T-Shirts $19 each
Plus $9.95 S/H (for US continent).
Various Rate for each Country
US Deliveries take up to 4 weeks

XS ($19)
S ($19)
M ($19)
L ($19)
XL ($19)
XXL ($25)
XXXL ($25)

Certificate of Individual/Group Participation after the event: Free + Shipping &Handling = $9.99/Each
US Deliveries take up to 4 weeks

Liability Waiver, Terms and Condition

I understand WSMX is not directly or indirectly running this event unless indicating WSMX’s direct operation location event. Therefore each location director is fully responsible for the event and must indicate and describe in written closure which each location director and organization is fully responsible for the event and WSMX is not responsible any and all accident and mishap. Each event director must uphold high standard in all aspect. If any individual, any organization, and director(manager/responsible person(s)) damage any image, reputation, and/or any of WSMX, individual, organization and/or director will be responsible to recover any and all the damages including any and all legal fees but not limited to the WSMX. I understand and agree to waive all claims and assume all risk of personal injury (including permanent disability, paralysis and death) occurring or sustained by me while traveling to, attending, or participating in the event or related activities or programs. I(including group/organization hereafter I) may sustain and assume all responsibility for wellbeing of myself, my heirs, personal representatives and assigns. I(We) will carry my(our) own personal or group liability insurance to cover and protect myself(ourselves) and WSMX. I release WSMX, WSMA, ISMA, USMAC, MPMA, organization, school(WSMX), any of its instructors, supervisors, assistants, volunteers, judges, officers, agents, successors or assigns associated with WSMX: and save harmless and indemnify WSMX from all losses caused by accident, injuries or deaths to the enrollee or to the third person who maybe contestants of the WSMX or program, In the event that either the contestants or said third person is injured in any way during the performance and execution of said event. Contestants consult your physicians before attending the event. I understand that this agreement is not transferable, I understand WSMX is not responsible any of my(our) program/event which is directed by me(us) and I will not claim my event is directed by WSMX and WSMX is not responsible any of your loss, your group or participants whatsoever. I will announce the safety rules and regulations to the participants before the event. I will not claim any refund or compensation unattended events or programs any related with this program at any reason at any time. I read and understand entirely the rules and regulations of the event. I will abide by said rules and regulations. If I violate these rules and regulations, I will be rejected or expelled without any refund, payment or compensation. I understand that if I violate it I will pay all the fees, losses, damages, legal fees and legal costs but not limited to the WSMX and WSMX related businesses and individuals. I understand that WSMX may use any of my and my family’s photos, videos pictures, voice and written documents once I have participated in the events and/or programs. I agree to waive all claim any compensation for any images of me to include pictures, videos, other media used in publicity or advertising of events that are held in conjunction with WSMX event to include but not limited to training, exhibitions, and/or other programs. I understand any submitted material, papers and/or information to WSMX will not be returned. I acknowledge that I have read and understand this agreement, liability waiver, rules and regulations entirely and completely.


By Clicking on this form you agree to be bound by the terms stated herein.