2025 national ChAmpionships

Name *

First Name

Last Name

Date of last seminar attended *

MM

DD

YYYY

I hold International Certificate

International Judge

International Referee

Events I am applying for: *

Please note that ticking the below boxes does not guarantee a position. Referees and judges will be selected by the tournament organiser based on the number of applications, grade, experience, etc

Full Contact Judge

Non Contact Judge

Full Contact Referee

Non Contact Referee

Declaration *

1. In participating in this event, I understand the risk of harm (including personal injury or death, damage to property or economic loss) 2. I release and waive all liability in respect of this event (or its agents, employees or contractors), that may otherwise have arisen as a result of my participation in the tournament.3. I understand that this event (or its agents, employees or contacts) will not be liable for the cost of treatment of any injuries that may be sustained as a result of participating. 4. I agree to obey by the rules of the tournament and any instructions given to me by the Chief of Referees and Judges or Tournament Organisers. 5. I am a current member of Matsushima Kyokushin Australia Inc. or agree to become a member for this event only. 6. I am a current member of MKA affiliated dojo 7. I hold current match official accreditation or intend to do so prior to the event. 8. I agree to attend the pre tournament briefing on Sunday.

Name

First Name

Last Name