Under Belt Divisions
Gup' s & Kyu's
* Means Not GKLC RATED AND NEW is for new students.
We hold the right to add or take away any division if less
then 3 competitors.
Under Belt FORMS
Team Forms
*White Belts 6 & Under (New Students)
5 & Under
6 NOV.  6 ADV.
7-8 NOV. ,7-8 INT., 7-8 ADV.
9-10 NOV.,9-10 INT., 9-10 ADV.
*White Belts 7-10 (New Students)
11-12 NOV.,11-12 INT.,11-12 ADV.
13-14 NOV.,13-14 INT.,13-14 ADV.
*White Belts 11- 15 (New Students)
15-17 NOV.,15-17 INT.,15-17 ADV.
18-34 NOV.,18-34 INT.,18-34 ADV.
35 & Over NOV. 35 & Over ADV.
Under Belt Weapons
*6 & Under All Ranks
8 & Under NOV. ADV.
9-10 NOV. ADV.
11-12 NOV. ADV.
13-14 NOV. ADV.
15-17 NOV. ADV.
18 & Over NOV. ADV.
35+ Nov., 35 + Adv
Under Belt Sparring
5 & Under All
6 NOV.,6 ADV.
7-8 NOV.,7-8 INT.,7-8 ADV.
9-10 NOV. Boys, 9-10 INT. Boys,9-10 ADV. Boys
9-10 NOV. Girls, 9-10 ADV. Girls
11-12 NOV. Boys, 11-12 INT. Boys, 11-12 ADV. Boys
11-12 NOV. Girls, 11-12 ADV. Girls
13-14 NOV. Boys ,13-14 INT. Boys ,13-14 ADV. Boys
13-14 NOV. Girls ,13-14 ADV. Girls
15-17 NOV. Boys ,15-17 INT. Boys,15-17 ADV. Boys
15-17 NOV. Girls ,15-17 ADV. Girls
18-34 NOV. Men, 18-34 INT. Men, 18-34 ADV. Men
18-34 NOV. Women ,18-34 ADV. Women
35 & Up NOV. Men ,35 & Up INT Men .,35 & Up ADV. Men
35 & Over NOV. Women, 35 & Over ADV. Women
45 & Up Nov. Men, 45 & ADV. Men
 SPECIAL NEEDS
Weapons    Forms     Sparring
Youth          Youth          Youth
Adult          Adult            Adult
NOW till January 15th 2010)
Price $45.00 All Events & 1 Free Spectator ($6.00 Value
)

At Door Registration $50.00 for 1 to 4 Divisions   
(No Personal Checks at the Door & No REFUNDS)

Spectators Fee (Same Price for Pre-reg or at the door):
5 & Under - Free , 6-12 Years Old -$4.00, 13 &Up- $6.00
All Non-Uniformed Black Belts have to pay spectators fee.

Name:__________________________ Age:_______      Rank: -New - NOV  - INT - ADV -
Address:_________________________ City_____________________________________
State or Providence __________________________ Zip__________________________
Contact Number (             )__________________________________________________
Karate School____________________________________________________________

Please enter myself or my son/daughter in the “ D-Lux Charity Challenge 3” Martial arts
tournament. In consideration of the acceptance of this form, I WAIVE any & all claims against
Adam Lux or any of the event sponsors, instructors, competitors for injury or illness which may
directly or indirectly result from my or my child’s participation. I understand that martial arts    
competitions exposes one to open and obvious danger and that the undersigned is fully aware
of and agrees to hold Adam Lux or any member of his staff Harmless. I also understand that
photographs may be taken at the event and later published or used for promotion and my
attendance at the event constitutes acceptance.

Singature_______________________________________________________Date:______

Parent or Guardian if under 18 year’s old____________________________ Date:_________


Make Checks to Adam D Lux.  
NO CHECKS AT THE DOOR!  CALL For Group/School Discount.