Date: November 4th, 2023 Hosted at Todd Elementary School45 Ingham Road, Briarcliff Manor, NY 10510 Registration Deadline: October 21, 2023Late Registration Deadline: October 28, 2023Competitor Registration Name* First Last Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Age*Please enter a number from 2 to 99.Gender* Belt Rank (BB Dan)* Dojang/School*- Please Select -UMAC BriarcliffUMAC Shurb OakUMAC ArdsleyHwarang White PlainsHwarang NanuetUMAC CarmelUMAC FishkillUMAC LaGrangeUMAC NewburghPark’s Champions TaekwondoSong Taekwondo AcademyMaster/Instructor* Emergency Contact Name* Emergency Contact Phone Number* Any Medical Conditions to be aware of?* Yes No Please state Medical Conditions*Ticket PricePlease Choose Your Events*One event is included in the registration fee. Each additional event is $20. Poomsae Breaking Sparring Peewee Paracourse (ages 4-6 only) HiddenEvent Included in Registration Discount $0.00 HiddenPeewee Discount $0.00 Total for ATMA Championship $0.00 Waiver* I understand that I will need to sign a liability waiver before participating Payment Information*Card Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
