Appendix 3

The 3rd china-korea International Wushu (Kungfu) Tournament Safety Statement

Print out to your printer and fax or airmail the completed statement to Mr. Che at the address or fax number below:

Che wen long
Manager
Northern China Si Ping Shao Lin Martial Arts Academy
Ye He Ancient Castle.Si Ping Ji Lin P R China
Postal Code:136523

TEL:+86 434 3560434
+86 434 3560348
Fax:+86 434 3263100

Safety Statement

I am a participant of The 3rd china-korea International Wushu(Kungfu)Tournament held at the Siping Shao Lin Martial Arts Academy August 2, 2007, and it is of my own will to participate in such event. I have already checked my health condition at an authorized and certified hospital or by a certified physician and I am physically fit for this tournament. I have already purchased personal safety insurance against accidental injury or accidental death. I will be responsible for my own personal safety. If any accident happens (which cause injury or fatality), no private individual or any authority has the right to blame or sue the organizing committee and organizers for causing such accident. I do acknowledge that the organizing committee has the right to use any image (photograph, film or videotape) of myself for various publication purposes.

Date signed: _________________________

Team Name:

Team Captain or Manager's (full) name:

Below, type or print clearly, each competitor's (full/complete) Name and show their (full/complete) signature to the right. Team Manager or Captain, acknowledge with your (full/complete) signature to right side of each competitor's signature


FULL NAME                                   SIGNATURE                               MANAGER'S / CAPTAIN'S SIGNATURE
-------------------                                  -------------------                               ----------------------------------------------------------