Anda di halaman 1dari 27

D W CU O p e n

Nomor: 012/E/8.2017
I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
Perihal: Undangan Yogyakarta, 20 Agustus 2017
Lamp. : 1 bundel

Kepada Yth :
Prof.Dr.R.Y Perry Burhan M.Sc
Selaku Ketua STEM Akamigas
Di tempat

Dengan hormat,

Bersama dengan ini kami Panitia Pelaksana Kejuaraan “DWCU Open Taekwondo
International Invitation Championships 2017”, bermaksud untuk
mengundangan Dojang / Club / Unit Kegiatan Mahasiswa (UKM) Taekwondo untuk
mengikuti Kejuaraan yang akan diselenggarakan pada :

Tanggal : 17 – 19 November 2017


Tempat : GOR UNY, Jl. Colombo Yogyakarta.

Adapun perihal detail dan rencana kejuaraan terlampir.

Demikianlah surat ini kami sampaikan, atas perhatian dan kerjasamanya kami
ucapkan terima kasih.

Mengetahui, Hormat kami.

Wakil Rektor III UKDW Panitia Pelaksana

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
D W CU O p e n
2017

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
PENDAHULUAN

Yogyakarta sebagai kota pelajar dan budaya, memiliki ciri budaya yang masih
dipegang teguh dan dijalankan oleh setiap warga dan masyarakat kota Yogyakarta,
selain itu banyaknya obyek wisata yang indah dan menarik untuk dikunjungi di
Yogyakarta membuat kami Taekwondo DWCU (Universitas Kristen Duta Wacana)
dalam kesempatan ini untuk mengundang semua tim dari Indonesia dan
mancanegara untuk menghadiri acara “DWCU OPEN TAEKWONDO
INTERNATIONAL INVITATION CHAMPIONSHIP 2017” pada tanggal 19
November 2017. Kejuaraan ini akan dilaksanakan di GOR UNY Yogyakarta -
Indonesia.

Semangat persaudaraan dengan tetap menjunjungi tinggi Sportivitas dan


kebersamaan bagi seluruh keluarga Taekwondo Indonesia menjadi dasar bagi
terlaksananya Kejuaraan ini. Oleh karena itu, Taekwondo DWCU ingin mengundang
tim Taekwondo untuk menghadiri acara “DWCU OPEN TAEKWONDO
INTERNATIONAL INVITATION CHAMPIONSHIP 2017” untuk ikut
berpartisipasi dalam kejuaraan tersebut.

Hormat kami,
Organizing Committee

Alan Cholin Parenta


Ketua Pelaksana

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
DWCU OPEN TAEKWONDO
INTERNATIONAL INVITATION CHAMPIONSHIPS 2017

INFORMATION/CONDITIONS OF PARTICIPATION
1 Tanggal 19th NOVEMBER 2017
Tempat GOR. UNY, Jl. Colomboi, Caturtunggal, Kec. Depok, Yogyakarta –
2 Pertandingan Indonesia 55281

Pelaksana DUTA WACANA CHRISTIAN UNIVERSITY


3
YOGYAKARTA TAEKWONDO ASSOCIATION

4 SANCTIONED BY TAEKWONDO INDONESIA ASSOCIATION (PB. TI)


COMPETITION
Current WTF Competition Rules 2017
5 RULES

 Individual (male/female) Festival Category :


1. Under 6 : Below 6 years
2. Under 8 : 7-8 years
3. Under 10 : 9-10 years
4. Under 12 : 11-12 years
5. Under 14 : 13-14 years
6. Under 16 : 15-17 years
KYORUGI 7. Above 17 : 18 years and above
6
 Individual (male/female) Category A :
 Super Cadet : 9 – 11 years
 Cadet : 12 – 14 years
 Junior : 15 – 17 years
 Senior : 17 years and above

Poomsae:
1. Individual (male/female)
POOMSAE
7 2. Pair of male and female
3. Team (3 athletes per team, no separate male and female

1. Mengisi Formulir Pendaftaran


2. Foto copy Sertifikat Geup PB TI / DAN Kukkiwon
Berkas Pendaftaran 3. Pas Foto 3 x 4 : 2 lembar
8 * Pendafataran dapat melalui email,
dengan melampirkan bukti transfer

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p

1. Setiap Juara pada tiap kelas atau kategori akan diberikan 1


2017
Medali Emas, 1 Medali Perak dan 2 Medali Perunggu.
2. Sistem pertandingan adalah Cut Off system dengan waktu :

30Sec.
Under 6 – 8 1 Minute 3R
Rest
30Sec.
Under 10-14 1 Minute 3R
Rest
1 30Sec.
Junior 3R
Min.30” Rest
1 30Sec.
Senior 3R
Min.30” Rest
Golden Point 1 Minute 1R
3. Kategori Prestasi ( Category A ) yang menggunakan
PSS System hanya untuk katgeori Junior (usia 15-17
tahun) dan kategori Senior (usia 18 th keatas ).
Regulation Untuk kategori Super Cadet ( usia 9 – 11 th ) dan Cadet
9 ( usia 12 – 14 th ) menggunakan DSS.
Point GAP 10, Point Ceiling 15 (all round)
4. Kategori Festival usia 6 sampai 28 tahun menggunakan
DSS, dengan Point GAP 10, Point Ceiling 12 (all
Round). Maksimal 4 orang dalam setiap bagan.
5. Setiap atlet yang akan bertanding harus siap di Ruang
Inspektion desk 30 minutes sebelum kelasnya
dipertandingkan.
6. Segala resiko cidera atau kecelakaan baik sebelum, saat dan
sesudah pertandingan menjadi tanggungjawab atlet sendiri.
7. Tidak diperkenankan perubahan kelas, nama setelah batas
waktu pendaftaran yang ditetapkan. Serta tidak ada
pengembalian uang pendaftaran jika telah melawati batas
waktu pendaftaran.
8. Bagi atlet yang di bawah usia 18 tahun wajib melampirkan
surat pernyataan orang tua / wali.
9. Jika persyaratan berkas atlet tidak lengkap, panitia berhak
untuk menolak atau atlet tersebut di diskualifikasi.
All teams must follow the regulations and competition rules.
 Pendaftaran sebelum tanggal 5 Oktober 2917 :

Individual : Rp. 250.000,-


Pair : Rp. 350.000,-
Team : Rp. 450.000,-
Biaya Pendaftaran
10
 Pendaftaran tanggal 6 Oktober – 5 November 2017 :

Individual : Rp. 350.000,-


Pair : Rp. 450.000,-
Team : Rp. 550.000,-

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
11 Biaya Protes Biaya Protes Rp. 1.000.000,-,
Kyorugi Category A :
1 – Medali Emas, 1 – Medali Perak, dan 2 – Medali Perunggu
Juara Umum Kyorugi Category A :
Trophy Juara Umum I
Trophy Juara Umum II
Trophy Juara Umum III

Krorugi Festival Kategori :


1 – Medali Emas, 1 – Medali Perak, dan 2 – Medali Perunggu
Juara Umum Kyorugi Festival Category :
Trophy Juara Umum I
Trophy Juara Umum II
Trophy Juara Umum III

Poomsae Category A :
1 – Medali Emas, 1 – Medali Perak, dan 2 – Medali Perunggu
Juara Umum Poomsae Category A :
Trophy Juara Umum I
Trophy Juara Umum II
PENGHARGAAN Trophy Juara Umum III
12
Poomsae Festival Category :
1 – Medali Emas, 1 – Medali Perak, dan 2 – Medali Perunggu
Juara Umum Poomsae Festival Category :
Trophy Juara Umum I
Trophy Juara Umum II
Trophy Juara Umum III

 Trophy Best Player Putera / Puteri :


 Kyorugi Category A
 Kyorugi Festival Category
 Poomsae Category A
 Poomsae Festival Category

 Trophy Best Coach


 Trophy Best Referee

*All athletes will receive the participation certificates.


*All coaches will receive the participation certificates.
Panitia hanya menyediakan peralatan pertandingan khusus kelas
Prestasi (Category A ) yang menggunakan PSS (Body + Sock ),
bagi team yang menggunakan peralatan PSS Panitia wajib
Peralatan
13 mengembalikan ke Panitia, jika Team / kontingen tidak dapat
Pertandingan
mengembalikan peralatan PSS yang di pinjam wajib mengganti
dengan merk yang sama langsung pada saat itu.

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
WAKTU Pendaftaran di buka pada : 1 September 2017
14 PENDAFTARAN Pendaftaran di tutup pada : 5 November 2017

Peserta adalah Taekwondo-in di bawah Naungan PB. TI

15 PESERTA Setiap kontingen diwajibkan untuk melampirkan rekomendasi dari


Pengda TI. atau dari Pengcab TI

BANK CENTRAL ASIA (BCA) Cabang Yogyakarta


16
ACCOUNT BANK Rekening Nomor : 0372411528
a.n. : Rr. E. SANNY HARSONO

1. BUDI SETIADI IBRAHIM


HP No : +6281 5688 7004

2. LUSIA ODILIA FRIANTI


CONTACT US HP No : +62813 5411 8586

E-mail : tkddwcu@gmail.com
Facebook : Tae Kwon Do DWCU

Hormat kami,
Wakil Rektor III UKDW Organizing Committee

Alan Cholin Parenta


Ketua Pelaksana
Pengda T.I. DIY

Ir. H. Krisniantara W.P.


Ketua Umum

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
SCHEDULE

17.11.17 12:00 Registration dan Daftar Ulang


14:00 Technical Meeting dan Drawing load
Jumat

18.11.17 12:00 Registration dan Daftar Ulang


14:00~17:00 Penimbangan Berat Badan
Sabtu

19.11.17 07:30 Persiapan Pertandingan


08.00 Pertandingan
Minggu
11:30~12:00 Upacara Pembukaan
12:00~13:00 Istirahat
13:00~18.00 Pertandingan
18:00 Pengalungan Medali

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
1. KYORUGI EVENTS
Equipment : Dobok (Uniform), mouth piece, arm – leg Protection, hand – foot
(socks, gloves) Protection, head gear and groin guard (inside the
Taekwondo Uniform)

Competition System: Single elimination tournament system

A. Festival Category :

Categories:

List of matches is made on the spot according to the Belt / Age / Weight /
Gender

No Class Years

1. Under 6 : Below 6 years

2. Under 8 : 7 – 8 years

3. Under 10 : 9 – 10 years

4 Under 12 : 11 – 12 years

5. Under 14 : 13 – 14 years

6 Under 16 : 15 – 17 years

7. Above 17 : 18 yeras and above

B. Category A :

Super Cadet : 9 – 11 years

MALE WEIGHT CATEGORY FEMALE


Below 23 Kg FIN Below 23 Kg
23.1 – 25.0 Kg FLY 23.1 – 25.0 Kg
25.1 – 28.0 Kg BANTAM 25.1 – 28.0 Kg
28.1 – 31.0 Kg FEATHER 28.1 – 31.0 Kg
31.1 – 34.0 Kg LIGHT 31.1 – 34.0 Kg
34.1 – 37.0 Kg WELTER 34.1 – 37.0 Kg
37.1 – 40.0 Kg LIGHT MIDDLE 37.1 – 40.0 Kg
40.1 – 45.0 Kg MIDDLE 40.1 – 45.0 Kg
45.1 – 49.0 Kg LIGHT HEAVY 45.1 – 49.0 Kg
Above 49 Kg HEAVY Above 49 Kg

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
Cadet : 12 – 14 years

MALE WEIGHT CATEGORY FEMALE


Below 33 Kg FIN Below 29 Kg
33.1 – 37 Kg FLY 29.1 – 33 Kg
37.1 – 41 Kg BANTAM 33.1 – 37 Kg
41.1 – 45 Kg FEATHER 37.1 – 41 Kg
45.1 – 49 Kg LIGHT 41.1 – 44 Kg
49.1 – 53 Kg WELTER 44.1 – 47 Kg
53.1 – 57 Kg LIGHT MIDDLE 47.1 – 51 Kg
57.1 – 61 Kg MIDDLE 51.1 – 55 Kg
61.1 – 65 Kg LIGHT HEAVY 55.1 – 59 Kg
Above 65 Kg HEAVY Above 59 Kg

Junior : 15 – 17 years

MALE WEIGHT CATEGORY FEMALE


Below 45 Kg FIN Below 42 Kg
45.1 – 48 Kg FLY 42.1 – 44 Kg
48.1 – 51 Kg BANTAM 44.1 – 46 Kg
51.1 – 55 Kg FEATHER 46.1 – 49 Kg
55.1 – 59 Kg LIGHT 49.1 – 52 Kg
59.1 – 63 Kg WELTER 52.1 – 55 Kg
63.1 – 68 Kg LIGHT MIDDLE 55.1 – 59 Kg
68.1 – 73 Kg MIDDLE 59.1 – 63 Kg
73.1 – 78 Kg LIGHT HEAVY 63.1 – 68 Kg
Above 78 Kg HEAVY Above 68 Kg

Senior : 17 years and above

MALE WEIGHT CATEGORY FEMALE


Below 54 Kg FIN Below 46 Kg
54.1 – 58 Kg FLY 46.1 – 49 Kg
58.1 – 63 Kg BANTAM 49.1 – 53 Kg
63.1 – 68 Kg FEATHER 53.1 – 57 Kg
68.1 – 74 Kg LIGHT 57.1 – 62 Kg
74.1 – 80 Kg WELTER 62.1 – 67 Kg
80.1 – 87 Kg MIDDLE 67.1 – 73 Kg
Above 87 Kg HEAVY Above 87 Kg

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
2. POOMSAE EVENTS

Equipment : Dobok (Uniform)

Competition System : Cut-Off

Rule : Current WTF Competition Rule

Criteria : Accuracy of basic Movement (Technique)


Speed and Power (exactitude)
Expression of energy

A. Festival Category ( Male / Female )

Grade / POOM /DAN Poomsae


Geup – 9 Taegeuk 1
Geup – 8 Taegeuk 2
Geup – 7 Taegeuk 3
Geup – 6 Taegeuk 4
Geup -5 Taegeuk 5
Geup – 4 Taegeuk 6
Geup – 3 Taegeuk 7
Geup 2 – 1 Taegeuk 8
Poom / DAN Koryo

B. Category A :

01 – Cut-off
Preliminary (Individual):
Contestants shall perform one of the two 1st Compulsory Poomsae.

Final(Individual):
Contestants are required to perform one of the two 2nd Compulsory Poomsae

Preliminary (Team):
Contestants shall perform one of the three 1st Compulsory Poomsae.

Final (Team):
Contestants are required to perform one of the three 2nd Compulsory Poomsae

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

DETAILS OF POOMSAE COMPETITION


I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
Method Division Age Compulsory Poomsae
Color Belt 10 ~ 5 Color Belt 4 ~ 1 Poom / Dan
1st TG1Jang TG2 Jang
Infant 04~06
2nd TG2Jang TG4Jang

3rd TG3Jang TG6Jang

1st TG2Jang TG4Jang TG6Jang


Cadet 07~12
2nd TG3Jang TG5Jang TG7Jang
Individual 3rd TG4Jang TG6Jang Koryo
1st TG2Jang TG4Jang TG7Jang
Junior 13~18
2nd TG3Jang TG6Jang Koryo

3rd TG4 Jang TG8Jang Taebaek


1st TG2Jang TG4Jang TG8Jang
Senior 19~30
2nd TG3Jang TG6Jang Keum Gam

3rd TG4Jang TG8Jang Pyongwon


1st TG2Jang TG4Jang Taebaek
Master I 31~40
2nd TG3Jang TG6Jang Koryo

3rd TG4Jang TG8Jang Sipjin


1st TG2Jang TG4Jang Keum Gam
Master II
Over 2nd TG3Jang TG6Jang TG8Jang
41
3rd TG4Jang TG8Jang Taebaek
1st TG4 Jang TG7Jang

Pair 2nd TG5 Jang Koryo

3rd TG6 Jang Taebaek

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
ATHLETE LIST
KYORUGI MALE / FEMALE
Festival category
Team Name: Country:

Name Date of Gender Age Poom/Dan/Keup Height cm Weight Category


Birth kg
M/ F PoomDan
Keup cm kg

M/ F PoomDan
Keup cm kg

M/ F PoomDan
Keup cm kg

M/ F PoomDan
Keup cm kg

PoomDan
M/ F Keup cm kg

M/ F PoomDan
Keup cm kg

M/ F PoomDan
Keup cm kg

PoomDan
M/ F Keup cm kg

PoomDan
M/ F Keup cm kg

M/ F PoomDan
Keup cm kg

M/ F PoomDan
Keup cm kg

M/ F PoomDan
Keup cm kg

M/ F PoomDan
Keup cm kg

M/ F PoomDan
Keup cm kg
PoomDan
M/ F Keup cm kg

M/ F PoomDan
Keup cm kg

Tournament Director reserved the right to Change or Modify Division as


necessary.

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
Entry Form
Kyorugi ( Male / Female )
Category A : Super Cadet (9 – 11 years )

Team Name: Country:

MALE WEIGHT CATEGORY FEMALE

FIN

FLY

BANTAM

FEATHER

LIGHT

WELTER

LIGHT MIDDLE

MIDDLE

LIGHT HEAVY

HEAVY

Name of Country/State/Club

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
Entry Form
Kyorugi ( Male / Female )
Category A : Cadet (12 – 14 years )

Team Name: Country:

MALE WEIGHT CATEGORY FEMALE

FIN

FLY

BANTAM

FEATHER

LIGHT

WELTER

LIGHT MIDDLE

MIDDLE

LIGHT HEAVY

HEAVY

Name of Country/State/Club

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
Entry Form
Kyorugi ( Male / Female )
Category A : Junior (14 - 17 years )

Team Name: Country:

MALE WEIGHT CATEGORY FEMALE

FIN

FLY

BANTAM

FEATHER

LIGHT

WELTER

LIGHT MIDDLE

MIDDLE

LIGHT HEAVY

HEAVY

Name of Country/State/Club

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
Entry Form
Kyorugi ( Male / Female )
Category A : Senior (18 years and above )

Team Name: Country:

MALE WEIGHT CATEGORY FEMALE

FIN

FLY

BANTAM

FEATHER

LIGHT

WELTER

MIDDLE

HEAVY

Name of Country/State/Club

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

ENTRY FORM
I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
TEAM OFFICIALS

The Organizing Chairman,


DWCU Open Taekwondo
International Invitation Championships 2017

Head of Team

Photo

Name :

Pasport No. :

Date of Birth :

Team Manager

Photo

Name :

Pasport No :

Date of Birth :

Team Coach

Photo

Name :

Pasport No :

Date of Birth :

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
CONTESTANT PARTICIPATION FORM
Age group
9 – 11 ( ) 12 – 14 ( ) 15 – 17 ( ) 18 above ( )

The Organizing Chairman, PHOTO


DWCU Open Taekwondo
International Invitation Championships 2017

Dear Sir/Madam,

I hereby apply to compete in the sparring event of the DWCU Open Taekwondo
International Invitation Championship 2017, to be held at the GOR UNY
Yogyakarta, from 18th – 19th November 2017.

Name
Date of birth Gender
Nationality
Present Grade/Dan Association
Weight (kg) Weight Category

I am aware of the possibility of me being injured in the full body contact sparring
hereby undertake and agree that I will not attach any blame to the Organizing
Committee of the DWCU Open Taekwondo International Invitation
Championship 2017. The Taekwondo Indonesia or their duly appointed officials
and other contestants or bring civil proceedings of any kind against the Said
organizations and the officials for injuries, losses, fatal or otherwise however, arising
in the course of my participation in the above Championship or any other incidental
thereto.

I hereby confirm that I have duly read and understand the above-mentioned terms
and conditions.

----------------------------------- --------------------------------------------
Signature of Signature of
Participant: Head Instructor:
Name : Name :

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
ATHLETE LIST
POOMSAE MALE / FEMALE
Festival category

Team Name: Country:

Name Date of Birth Age Gender PoomDan/Keup Division / Category


PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

PoomDan
M/F Keup

Tournament Director reserved the right to Change or Modify Division as


necessary.

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

FORM FOR POOMSAE CATEGORY A


I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
a. Individual Division

Category Name Date of Birth Passport No. /


(dd/mm/yy) I/ C Number
M
Infant
4 – 6 years F

M
Cadet
7 – 12 years F

M
Junior
13 – 18 years F

M
Senior
19 - 30 years F

M
Master I
31 - 40 years F

M
Master II
41 years above F

Name of Country/State/Club

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
b. Pair Division

Category Name Date of Birth Passport No. /


(dd/mm/yy) I/ C Number
M
Infant
4 – 6 years F

M
Cadet
7 – 12 years F

M
Junior
13 – 18 years F

M
Senior
19 - 30 years F

M
Master I
31 - 40 years F

M
Master II
41 years above F

Name of Country/State/Club

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
CONTESTANT PARTICIPATION FORM
Age group
9 – 11 ( ) 12 – 14 ( ) 15 – 17 ( )18 above ( ) Pomsae ( )

The Organizing Chairman, PHOTO


DWCU Open Taekwondo
International Invitation Championships 2017

Dear Sir/Madam,

I hereby apply to compete in the sparring event of the DWCU Open Taekwondo
International Invitation Championship 2017, to be held at the GOR UNY
Yogyakarta, from 18th – 19th November 2017.

Name
Date of birth Gender
Nationality
Present Grade/Dan Association
Poomsae Category Division

I am aware of the possibility of me being injured in the full body contact sparring
hereby undertake and agree that I will not attach any blame to the Organizing
Committee of the DWCU Open Taekwondo International Invitation
Championship 2017. The Taekwondo Indonesia or their duly appointed officials
and other contestants or bring civil proceedings of any kind against the Said
organizations and the officials for injuries, losses, fatal or otherwise however, arising
in the course of my participation in the above Championship or any other incidental
thereto.

I hereby confirm that I have duly read and understand the above-mentioned terms
and conditions.

----------------------------------- --------------------------------------------
Signature of Signature of
Participant: Head Instructor:
Name : Name :

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
ENTRY FORM

Group Indemnity

Name of Team Head :

Position In Association :

National Association :

Address :

I as the name above hereby declare and confirm that the liability insurance has been
affected for all the officials and contestants from
participating in the DWCU Open Taekwondo International Invitation Championship
2017 (Yogyakarta).

This insurance covers all the damages to persons and indemnifies the Taekwondo
Indonesia and its organizer against all damages, claims and demands in respect
therefore.

Signature :…………............………………………………

Name :

Passport No :

Date :

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
D W CU O p e n

I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
2017
INDEMNITY FORM

The Organizing Chairman,

Dear Sir/Madam,

MEMBER UNDER 18 YEARS OF AGE (SPARRING EVENT)

I, ………………………………………………….. as Parent / Guardian give full permission to

my son / daughter /

ward..................................................................................................................

to participate in the DWCU Open Taekwondo International Invitation Championship


2017 to be held at Gor UNY, Yogyakarta - Indonesia from the 18th – 19th
November 2017.
I do further agree to absolve the Instructors, Officials, Participants, Organizing
Committee, Taekwondo Indonesia, Organizing Committee, from any blame and
responsibility in the event of any injuries, losses, fatal or otherwise arising in the
course of my son / daughter / ward’s participation in the above Championship or any
activities incidental thereto.

I hereby confirm that I have duly read and understood the above mentioned terms
and conditions.

Yours sincerely,

…………………………………………….
(Signature of Parent / Guardian)

Name :

Date :

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
D W CU O p e n
2017

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com
I nt e n a t i o n a l I n v i t a t i o n c h a m p i o n s h i p
D W CU O p e n
2017

Gedung Sekretariat UKM Bersama , Universitas Kristen Duta Wacana


Jl. Dr. Wahidin No. 5 - 25, Yogyakarta 55224 E-mail: tkddwcu@gmail.com