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Advanced BKJ's
Brazilian
Jiu-Jitsu Tournament
Pre-Registration
PRE-REGISTRATION
FORM (Deadline coming soon)
Fees:
Pre-Registration = $35 to compete in one event, $40 to compete in
everything (gi, no gi, etc)
Day of the event = 50$ to compete in one event, 55$ to
compete in everything (gi, no gi, etc)
Competitor's Name___________________ _________________
Male [ ] Female [ ]
Birth Date _____/_____/_____ Age _____
E-Mail______________________
Address__________________________________
Home Phone ( ) ____________________
City_________________ State______ Zip__________________
Belt Rank__________________
Martial Arts School___________________
Instructor___________________ Team_____________
Important Information
Please
fill out ALL of the above information and ALL of the events
that you plan on fighting in. Include these, along with your
waiver when mailing forms out. It is also very important to
email this information when using PayPal but your waiver still has to be
mailed or faxed.
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MEN'S
ADULT NO-GI GRAPPLING DIVISIONS:
WEIGHT
CLASSES (Choose one):
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150 & Under (Flyweight)
_____
151-170.9 (Lightweight)
_____
171-190.9 (Middleweight)
_____
191-210.9 (Light Heavyweight)
_____
211 & Above (Heavyweight)
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WOMEN’S
ADULT NO-GI GRAPPLING DIVISIONS:
WEIGHT
CLASSES (Choose one):
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_____
135 & Under (Lightweight)
_____
136 & Over (Middleweight)
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TEEN NO-GI
(Ages 15, 16, & 17):
Divide
Weights at the event
____
Approximate weight
ADULT
GI GRAPPLING DIVISIONS:
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MEN’S
- WHITE BELT
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_____
150 & Under (Flyweight)
_____
151-170.9 (Lightweight)
_____
171-190.9 (Middleweight)
_____
191-210.9 (Light Heavyweight)
_____
211 & Above (Heavyweight)
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MEN’S
- BLUE BELT
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_____
150 & Under (Flyweight)
_____
151-170.9 (Lightweight)
_____
171-190.9 (Middleweight)
_____
191-210.9 (Light Heavyweight)
_____
211 & Above (Heavyweight)
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MEN’S
- PURPLE BELT & ABOVE
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_____
150 & Under (Flyweight)
_____
151-170.9 (Lightweight)
_____
171-190.9 (Middleweight)
_____
191-210.9 (Light Heavyweight)
_____
211 & Above (Heavyweight)
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Women's Skill Levels May Be Combined |
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WOMEN’S
WHITE BELT DIVISIONS
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_____
135 & Under (Lightweight)
_____
136 & Over (Middleweight)
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Women's Skill Levels May Be Combined |
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WOMEN’S
BLUE AND ABOVE BELT DIVISIONS
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_____
135 & Under (Lightweight)
_____
136 & Over (Middleweight)
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TEEN
GI DIVISIONS
(Ages 15, 16, & 17):
Divide
Weights at the event
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____
Approximate weight
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Waiver Of Injury
I, (print name) ______________________________________,
the undersigned hereby release Advanced Boxing, Kickboxing, & jiu-Jitsu
(Advanced BKJ), Butch Hiles, and any and all other persons associated with this
event in any capacity, from any and all liability due to injuries that may incur
as a result of my attendance and/or participation at this event. Furthermore, I
hereby waive any compensation whatsoever for the use of pictures or video
production of myself, utilized by those associated with this event, for any
profit-making at anytime. I agree to indemnify, defend and hold
harmless all the above named parties from any liability. I clearly
understand that the fighting aspect of this sport and competition involves
bodily contact. Submission grappling is a very dangerous sport. The organization
sponsoring this training will not assume financial or other responsibilities for
injuries or illness suffered from or related to this competition, nor will they
be responsible for any loss to attendees as a result of damages of their person
or personal items through fire, theft or other causes. Injuries to joints, bones
and muscles are possible when you grapple in this type of competition. Serious
injuries are possible due to the nature of the activity. Grappling is an
extremely taxing sport, and by signing below you indicate that you are in
adequate physical condition to engage in this type of activity and accept
responsibility for injuries, etc. that may occur. I have read, understand
and agree to abide by the rules associated with the Advanced BKJ Jiu-Jitsu
Tournament and assume all responsibility and any associated liability for
infringement of such rules. Additionally, I am fully aware of my personal
medical condition and hereby certify that I am mentally and physically fit to
compete at the Advanced BKJ Jiu-Jitsu Tournament.
__________________________________________________
Competitors Signature Date
__________________________________________________
Signature of parent / guardian who assumes complete responsibility (if under
the age of 18)
Check or Money Orders Made Payable To: =
Butch Hiles
309 Redwood Drive
Charleston, WV 25302
Make sure you enclose ALL of the necessary information
Fax: 14198310444
Or Pay by PayPal:
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**Hot News**
New Location
Bigger & Better then
ever!!!
Come check us out at our
brand new facility:
410
Summers Street
Charleston,
WV
25301
Now offering: Brazilian
Jiu-Jitsu, MMA, Kickboxing, Boxing, Judo, Aerobics, & More!!!

Butch Hiles is the areas only certified
BJJ black belt
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with the largest martial arts site in West Virginia, as well as one of the most
visited nationally, please inquire here:
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Different rates and options available
Email
for additional Information
Big
Victories

Congrats to Dr. Bowman and his son for
their big wins in a recent Judo and Jiu-Jitsu tournament
New promotions

Congrats to everyone who got promoted on
3/21/09
Butch Hiles BJJ & MMA added some new
BJJ purple and blue belts!!!
More
Pictures HERE
Classes
When: Monday, Wednesday,
and Sunday
Morning Class is on Wednesday 9-10:30AM
Where: North Charleston Community Center
2009 Seventh Avenue
Charleston, WV 25312
And
Morning
Class and Sunday Class are located at:
1033
Quarrier Street
Charleston,
WV
CLICK
HERE
call for more information:
(304)549-9370
Private
Lessons Available by Appointment
Mike Sheppard successfully defends
his title

Mike Sheppard
West Virginia Cruiser
Weight Boxing Champion
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up to Date
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is continuing to make changes to benefit
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Look for more site updates, locations,
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