Professional Documents
Culture Documents
Registration Form
Registration Form
Address
Are registering to attend and joint The International Pencak Silat Championship 2015 Earlyaged / Pre-Teenagers / Teenagers / Adults Level with a team that consists of:
A. OFFICIAL
a. Team Manager
: ....
b. Coach
: 1. ....
2. ....................................
B. ATHLETES
The list of our athletes will be listed of the attachment.
., //2016
Contingent/Perguruan
Official/Team Manager
___________________
(Full Name)
REGISTRATION FORM
EARLY-AGE / PRE-TEENAGERS / TEENAGERS / ADULTS CATEGORY*
Contingent / Perguruan : .
MALE
WEIGHT
CLASS
FEMALE
A
B
C
D
E
F
G
H
I
J
MALE
SENI
CATEGORY
TUNGGAL
GANDA
BEREGU
*) Choose one
FEMALE
ATHLETES DATA
CATEGORY
Full Name
: .
Sex
: Male / Female*
Address
Height, Weight
: cm, .kg
Blood Type
: A / B / O / AB*
Contingent / Perguruan :
Will be join The International Pencak Silat Championship FIGHTING Category in weight
class:
MALE
FEMALE
*)choose one
PASSPORT PHOTO
4X6
3X4
3X4
4X6
.. , .2016
Contingent / Perguruan .
Official / Team Manager
..
Can be copied as much as needed
ATHLETES DATA
CATEGORY
Full Name
: .
Sex
: Male / Female*
Address
Height, Weight
: cm, .kg
Blood Type
: A / B / O / AB*
Contingent / Perguruan :
Will be join The International Pencak Silat Championship SENI IPSI in category:
MALE
FEMALE
*)choose one
PASSPORT PHOTO
4X6
3X4
3X4
4X6
.. , .2016
Contingent / Perguruan .
Official / Team Manager
..
Can be copied as much as needed
LETTER OF RECOGNITION
The Undersigned below,
Name
: ..
Position / Occupation : ..
States that our Perguruan Pencak Silat
is registered in Pencak Silat
Associations with registration number:
With this letter I guarantee that my statement above is true and correct. If there are
any matters or problems related to this letter, I would like to take all of the responsibilities
and consequences that occur.
., ..2016
(.)
Full Name
: ___________________________________________________________________
(Full name)
Of
: ___________________________________________________________________
(Contingent/perguruan name)
2. Understand that any video footage/photos/other images taken at the International Pencak
Silat Championship 2016 may be shown in a public environment (in Jakarta, interprovincial
and/or overseas)
Name
Occupation
Cellphone Number
Status
Name
Sex
Contingent/Perguruan
To attend and join International Pencak Silat Championship 2016 hosted by Al Azhar Seni
Bela Diri on May 5th-7th 2016 in Padepokan Pencak Silat TMII Jakarta, Indonesia. With this
letter we state our support this event and would not sue championships committee or coach
to any authorities institutions if something happened to my child (injury) caused by the
championship after the medical treatments was given by doctors or any other apparatus that
authorized by in the championship.
(..)
Parents full name
Name
Sex
Contingent/Perguruan
Is willing to attend and join International Pencak Silat Championship 2016 hosted by Al
Azhar Seni Bela Diri on May 5th-7th 2016 in Padepokan Pencak Silat TMII Jakarta,
Indonesia. With this letter I state my support this event and would not sue championships
committee or coach to any authorities institutions if something happened to myself (injury)
caused by the championship after the medical treatments was given by doctors or any other
apparatus that authorized by in the championship.
(..)
Athletes full name
TEAM DATA
Contingent/Perguruan
: ..
Address
NO
NAME
OCCUPATION/POSITION
Note:
1. Team Data Forms contain all of the people that will attend the International Pencak
Silat Championship 2016 including non-athletes (coaches, officials, parents, etc.)
2. In the occupation/position column please write down your position on the team
(coaches, officials, athletes, parents, etc.)
3. The registration fee paid based on the number of people listed on the team data form
4. Any unlisted person would not be provided any facilities from the championship
committee