2010 WKA MIDWEST OPEN KUM DO CHAMPIONSHIPS

SATURDAY, SEPTEMBER 11, 2010

AT BLACK HAWK COLLEGE

6600 34TH Avenue MOLINE, ILLINOIS 61265,USA

The Midwest WKA is sponsoring the 2010 WKA Midwest Kum Do Championships which is being hosted by the Sei Kum Kwan Dojang of Moline.

The tournament is scheduled for Saturday, September 11, 2010 at Black Hawk College in Moline, Illinois in the lower gym of Building #3. The Kum Do tournament, training and Black Belt testing will start at 9 am. All participants should register with their instructors. The Kum Do instructors must have their students registered by August 31, 2010. Each instructor must send in one check to pay all the tournament fees and include entry forms for all participants from their schools. The entry fee is $40 per participant. Lunch is included in the fee. Please contact Dr. David Birdsell with any questions at: (309) 235-3132 or email: davidbirdsell@sbcglobal.net

NAME_________________________  DOJANG_______________________________

ADDRESS___________________________ CITY____________ STATE____ ZIP___

DIVISIONS:               ____YOUTH (UP TO 15)          ____WOMENS

     ___NON-BLACK BELT (16 AND UP)       ____ BLACK BELT       _______  TEAM

INSTRUCTOR:_________________ INSTRUCTORS SIGNATURE_____________

WAIVER: I release the World Kum Do Association, its affiliated schools, staff, and Black Hawk College of Moline

from any injuries that I may suffer at this event.

PARTICIPANT¡¯S SIGNATURE:___________________      DATE__________

PARENT¡¯S SIGNATURE (IF UNDER THE AGE OF 18)______________________

(MAKE CHECK PAYABLE TO THE WKA)   MAIL TO: Dr. David Birdsell,

                                                                                         PO Box 394, Moline, IL 61266