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World Congress of Martial Arts World Congress of Martial Arts World Congress of Martial Arts

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World Congress Martial Arts (WCMA)
2015 USA Open Martial Arts
Championship

July 18-20, 2015

Hotel Reservation

After submitting this information, you should receive an e-mail with PayPal payment instructions.

Required fields are starred(*).

Number of Passengers:

Note: This will fill in unused fields below for extra passengers, clearing any information you've entered.

Passenger #1

*Legal Name w/middle name (passenger #1):
*Address:
*City:
*State/Province:
*Zip/Postal Code:
Country:
*Home Telephone:
Business Telephone:
Cell Phone:
*Emergency Contact Name:
*Emergency Contact Phone Number:
Email Address:
Gender:
*Date of Birth:
Passport Number:
Passport Expiration:
Citizenship:


Departure City:
Tee-Shirt Size:
Are you a competitor?:
If yes, how many years have you been training?:
Who is your coach?:
What age will you be in 2015?:

Passenger #2

*Legal Name w/middle name (passenger #2):
*Address:
*City:
*State/Province:
*Zip/Postal Code:
Country:
*Home Telephone:
Business Telephone:
Cell Phone:
*Emergency Contact Name:
*Emergency Contact Phone Number:
Email Address:
Gender:
*Date of Birth:

Passport Number:
Passport Expiration:
Citizenship:


Departure City:
Tee-Shirt Size:
Are you a competitor?:
If yes, how many years have you been training?:
Who is your coach?:
What age will you be in 2015?:

Passenger #3

*Legal Name w/middle name (passenger #3):
*Address:
*City:
*State/Province:
*Zip/Postal Code:
Country:
*Home Telephone:
Business Telephone:
Cell Phone:
*Emergency Contact Name:
*Emergency Contact Phone Number:
Email Address:
Gender:
*Date of Birth:

Passport Number:
Passport Expiration:
Citizenship:


Departure City:
Tee-Shirt Size:
Are you a competitor?:
If yes, how many years have you been training?:
Who is your coach?:
What age will you be in 2015?:

Passenger #4

*Legal Name w/middle name (passenger #4):
*Address:
*City:
*State/Province:
*Zip/Postal Code:
Country:
*Home Telephone:
Business Telephone:
Cell Phone:
*Emergency Contact Name:
*Emergency Contact Phone Number:
Email Address:
Gender:
*Date of Birth:

Passport Number:
Passport Expiration:
Citizenship:


Departure City:
Tee-Shirt Size:
Are you a competitor?:
If yes, how many years have you been training?:
Who is your coach?:
What age will you be in 2015?:
Director's Last Name:


Type Of Travel Requested:


When do you plan on checking in?
Number of Nights:


Type Of Room:


*Smoking or Nonsmoking Room:
Number of Beds:
*Window or aisle seating on an airplane?
*Form of Payment:

Please send a $60USD check per competitor made payable to Dr. Terry Free within 7 days of this reservation being submitted. The address is:

Dr. Terry Free
240 Shelley Ave
Pollok, TX 75969

Within 48 hours of completing this form you should receive
an e-mail invoice with PayPal payment instructions.

If you have any questions at all, please contact
Papa Dan Travel toll-free: 855-391-3942!

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