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Judo Registration Form

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Participant Information

Contact Email *

Participant First Name *

Participant Last Name *

Participant Birthdate *

Participant Gender *

Male

Female

Country *

Street Address (w/Apt#) *

City *

State *

County *

Zip Code *

Phone *

Would you like to receive important event text alerts on this number (eg. changes or delays)?

Emergency Contact Name *

Emergency Phone *

Which race or ethnicity best describes you? *

American Indian or Alaskan Native

Asian

Pacific Islander

Black or African American

Hispanic / Latino

White / Caucasian

Multiple Ethnicities / Other

First and Last Name of the Student Ambassador. *

Please be precise - this could help them win a SCHOLARSHIP!

Event Information

Age Division *

Juniors (5-12)

Teens, Seniors, Veterans 1, Veterans 2 (13-50, 51+)

Juniors Breakdown *

5-6

7-8

9-10

11-12

Age Breakdown *

Teens 13-15

Teens 16-17

Seniors 18-29

Veterans 1 30-40

Veterans 2 41-50

51+

Juniors Weight Classes (including the Judo gi) *

Weight will be taken before competition

Weight Classes (including the Judo gi) *

Weight will be taken before competition

Experience/Belt Level *

Novice- Judo White, Yellow, and Orange Belts

Intermediate- Judo Green Belts

Advanced- Judo Brown and Black Belts

Proof of Membership one of the Judo National Governing Bodies

Organization *

USJA, USJF, ATJA, or USA Judo

Membership Number *

Registered School *

Certified Coach *

Do you train in another martial art or any grappling style sport (including wrestling)? *

Yes

What martial art? *

Rank and Tenure? *

Make a Donation

Adopt an Athlete
click here, to learn more about this cause

Amount $

Waiver *

I have read and agreed to the TERMS *
Click here to view the TERMS.

Is the participant 18 or older? *

18 or older Under 18

Payment Details

Discount or Tracking Code

Apply

Do not COPY & PASTE the code, please type it into this field.

Price

Discount (-)

Handling

Donation

Total Owed

Payment Method

Visa

Mastercard

Purchase Purchase Cancel

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