To be added to the reserve list for your age group for the NSW Black Belt Tournament, please complete the details below. We’ll notify you if a place becomes available: Personal details:First name*Last name*Age at time of competition*Phone number*Address line 1*Address line 2Address line 3Town/City*State*Select...NSWVICSAQLDWATASPostcode*Competitor information:Please add me to the reserve list for: Kata (male) Kumite (male) Kata (female) Kumite (female) Age group14 - 17 years old18 - 34 years old35 - 49 years old50+ years oldRegion*Enter training regionRegion 01 NSWRegion 02 NSWRegion 03 NSWRegion 04 NSWRegion 05 VICRegion 06 VICRegion 07 VICRegion 08 VICRegion 09 SARegion 10 QLDRegion 11 QLDRegion 12 WARegion 13 WARegion 14 NSWRegion 15 NSWRegion 16 ACTRegion 17 NSWRegion 18 TASRegion 21 NSWRegion 23 SARegion 24 QLDRegion 25 QLDRegion 26 VICRegion 28 WARegion 29 QLDRegion 17 HAMILTON NZRegion 18 MANUKAU NZRegion 19 AUCKLAND NZRegion 21 WELLINGTON NZRegion 22 CHRISTCHURCH NZDojoPlease check the boxes below if any of these statements are true: Do you have any allergies? e.g. aspirin, antibiotics, foods? Have you been in contact with any contagious diseases in the last 3 months? Are you taking any form of medication at present? If the answer is yes to any of the above questions, please give details here:Doctor's details:Doctors name*Doctors phone number*Doctors address*Emergency Contact Details:Contact one name*Contact one relationship*Contact one phone number*Contact one alt. number*Contact two name*Contact two relationship*Contact two phone number*Contact two alt. number*Declaration* By checking this box, you are agreeing to the Terms and Conditions.