Purchaser/Registrant Name *

Athlete Last Name

Athlete First Name

Phone *

Email *

Competitor Date of Birth *

Gender *

Weight in Lbs *

Belt Rank *

Martial Arts Studio *

Waiver Agreement *

I certify that I have read and agree to the Phoenix Iron Gauntlet Participant Waiver and Release of Liability. If the participant is under 18 years of age, I certify that I am the participant's parent or legal guardian and agree on the participant's behalf.