registrationform

International Martial Arts Championship 2008 Registration Form

Name of School :　Fuchukan　Japan		Contact Address :
Representative: Katsuhiko Mochizuki		Instructor : Shoji Ozawa Contact Person : Katsuhiko Mochizuki			Telephone No. : Fax No.
Group：（A. Category B. Participants 5 - 10 persons）
x1.Tai Chi Chuan			x 2.Xing-Yi Chuan
Name	Passport ID	Date of Birth	Name	Passport ID		Date of Birth	Remarks
Katsuhiko Mochizuki			Katsuhiko Mochizuki
Sachiko Ezawa			Sachiko Ezawa
Takahiko Yamada			Takahiko Yamada
Yukihiko Kanari			Yukihiko Kanari
Umeko Masuda			Umeko Masuda

Page1-Group

Individual : Choose individual competition items in the box except Tai Chi will be determine by draw during competition

Name	Passport ID	Date of Birth	Tai Chi		Xing Yi		Weapons		Ba Gua
Name	Passport ID	Date of Birth	check	Draw	check	choose	check	choose	check	choose	choose
Katsuhiko Mochizuki			X		X	Za shi Chui	X	Double Swords Last 4	X	You Shen Zhang Last 4	Bian Huan Zhang First 4
Sachiko Ezawa			X		X	Wu Xing Xiang Sheng + Ji Xing Shi Ba	□		□
Takahiko Yamada			X		X	Dragon form + Lian Huan Chuan	X	Xing Yi Wu Lang Staff	□
			□		□		□		□
			□		□		□		□
			□		□		□		□
			□		□		□		□

Page2- Individual

All around :

Page3- All around
Representative Signature : Katsuhiko Mochizuki 07.7.2008