North American Event Info North American Registration and Materials North American Divisions North American Rules

Registration- 2010 USBA/WBA and ISKA North American Breaking Championships

As of 5/30/2010 Competitors may only register for Creative Wood and Open. There are no extra materials and you will have to bring your own materials for those 2 divisions. Call Ralph Bergamo for more details- 203-410-1417.

Online Registration and Materials        Registering by mail

Online Registration and Materials (click here for division chart): Pre-registration pricing ends May 22, 2010- $50 for 1st division and each ISKA division, $15 for second division, $10 each additional division.

To register securely online please complete the following information in it's entirety and click "submit" at the bottom of the form. You will then be taken to the payment page for secure payment through "PayPal". You will also be able to order your materials and spectator tickets from the payment page.

Competitor Info  
Name  
Male/Female  
Birth Date (Month/Day/Year)  
Age  
Name of Parent/Guardian if under 18  
Street Address  
   
City  
State  
Country  
Zip Code  
Home Phone  
Cell Phone  
E-mail  
Years of training  
Rank/Style  
Weight (in lbs)  
Organization/Federation Association  
Emergency Contact Name  
Emergency Contact Relationship  
Emergency Contact Home Phone  
Emergency Contact Cell Phone  
Emergency Contact Work Phone  
Emergency Contact E-mail  
Studio Info  
Studio Name  
Head Instructor  
Studio Street Address  
   
Studio City  
Studio State  
Studio Zip Code  
Studio Phone  
Studio Website  
Divisions Entered Division Numbers Only
First Time Breakers (Cannot enter other divisions)  
Creative Multi-Directional Wood Breaking  
Creative Open Breaking  
Power Concrete Hand  
Power Concrete Elbow  
Power Concrete Foot  
Speed Board Breaking  
High Jump Board Breaking  
Power Board Hand  
Power Board Elbow  
Power Board Foot  
ISKA Creative Open  
ISKA Power Concrete  
ISKA Power Wood Foot  
Total number of divisions entered  
I hereby submit my registration form to the 2010 USBA/WBA and ISKA North American Breaking Championships. I agree to save & hold harmless USBA/WBA (USBA llc), ISKA, Management, Sponsor, Sacred Heart University, their officers, agents, members & employees from any & all liability resulting from injuries to any person or for damages to or loss of property owned or controlled by me. I fully understand and shall adhere to all rules and regulations. I release all photo & video rights that may be used for publicity, promotion and/or media release without any form of compensation.  

Signature (Parent or Guardian if under 18):

Your signature confirms that you have read

and approve of the above release

Your entry at right will act as your signature

 

 
Registration by Mail:

(click here for division chart)     (click here to download registration form)     (click here to download materials request form):

To register by mail please download the divisions, registration and materials request form above. Fill in the registration, using divisions from division chart, and materials forms completely and return with payment to the address on the form.