How many COMPETITORS from the same FAMILY are you going to register?* 1 Competitor Name* Address
Mobile Phone
Email*
Dojo/Club* Select your dojo/club Atlas Extreme Awadallah Judo Barrington Chicago Police Judo Club Chicago Tenri Club Olympia Cohen Brothers Des Moines Judo Academy Dynamo Evolution Dojo Fox Valley Judo & Jujitsu Club Fukutsu No Seishin Judo Club Godai Grappler Station Gurnee Hit Squad Hogosha Judo Hollis Park Judo Huntsville Judo Club Illinois Elite Judo Jiu Jitsu Institute Joplin Judo & Jiujitsu Ju Shin Kan Judo Judo-Jiujitsu of Madison Kims Judo Green Bay Kito Kan Kokushi Dojo Kokushi Midwest Madison Judo Menomonee Michigan State University Midway Judo West Saint PaulMN Missouri Martial Arts Northglenn Judo Oak Lawn Powersource Pride Martial Arts Quad City Judo Academy Selkirk Judo Club Shindo Kan Judo Silicon Valley Judo Sioux Falls The Gym Lake Orion Tohkon Judo Academy University of Chicago Judo Wahadachi Wakaishu Judo Club Warrior Judo Club White Dragon Judo Club Wisconsin Dells Judo Dojo Wisconsin Judo Club Yorkville Yu-Tora Judo OTHER
Provide dojo/club name
Sensei / Instructor
1 Date of Birth*
Date Format: MM slash DD slash YYYY
1 Gender* 1 Belt Color* 1 Judo Affiliation* 1 Please provide other affiliation and country
1 Judo Card Number
1 Judo Card Expiration Date
Date Format: MM slash DD slash YYYY
Does Competitor 1 require assistance or accommodation? 1 Please let us know what type of assistance or accommodation is requested, and/or provide the name of the person who will be assisting you.
1 Waiver & Signature for Competitors 18 years of age & over WARNING!
1 Waiver & Signature of Minor's Parent/Guardian WARNING!
Competitor 1 is competing in* 1 Shiai / Tournament Please select Competitor 1's division: Select one division only.
Do you want to register Competitor 1 for a second division? 1 Please select the second division: 1 If the second division is the same as the first, what is your preference? Do you want to register Competitor 1 for a third division? 1 Please select the third division: 1 If the third division is the same as one of the others, what is your preference? 1 Kata Competition 1 Kata Only - Form Select one Kata form only.
1 Kata Form 1 Tori Name
1 Uke Name
Do you want to register Competitor 1 for a second kata? 1 Second Kata Form 1 Tori Name 2
1 Uke Name 2
Do you want to register Competitor 1 for a third kata? 1 Third Kata Form 1 Tori Name 3
1 Uke Name 3
Second Competitor 2 Competitor Name
First
Last
2 Date of Birth
Date Format: MM slash DD slash YYYY
2 Gender 2 Belt Color 2 Judo Affiliation 2 Please provide other affiliation and country
2 Judo Card Number
2 Judo Card Expiration Date
Date Format: MM slash DD slash YYYY
Does Competitor 2 require assistance or accommodation? 2 Please let us know what type of assistance or accommodation is requested, and/or provide the name of the person who will be assisting you.
2 Waiver & Signature for Competitors 18 years of age & over WARNING!
2 Waiver & Signature of Minor's Parent/Guardian WARNING!
Competitor 2 is competing in* 2 Shiai / Tournament Please select Competitor 2's division: Select one division only.
Do you want to register Competitor 2 for a second division? 2 Please select the second division: Select one division only.
2 If the second division is the same as the first, what is your preference? Do you want to register Competitor 2 for a third division? 2 Please select the third division: 2 If the third division is the same as one of the others, what is your preference? 2 Kata Competition 2 Kata Only - Form Select one Kata form only.
2 Kata Form Select one Kata form only.
2 Tori Name
2 Uke Name
Do you want to register Competitor 2 for a second kata? 2 Second Kata Form 2 Tori Name 2
2 Uke Name 2
Do you want to register Competitor 2 for a third kata? 2 Third Kata Form 2 Tori Name 3
2 Uke Name 3
Third Competitor 3 Competitor Name
First
Last
3 Date of Birth
Date Format: MM slash DD slash YYYY
3 Gender 3 Belt Color 3 Judo Affiliation 3 Please provide other affiliation and country
3 Judo Card Number
3 Judo Card Expiration Date
Date Format: MM slash DD slash YYYY
Does Competitor 3 require assistance or accommodation? 3 Please let us know what type of assistance or accommodation is requested, and/or provide the name of the person who will be assisting you.
3 Waiver & Signature for Competitors 18 years of age & over WARNING!
3 Waiver & Signature of Minor's Parent/Guardian WARNING!
Competitor 3 is competing in* 3 Shiai / Tournament Please select Competitor 3's division: Select one division only.
Do you want to register Competitor 3 for a second division? 3 Please select the second division: Select one division only.
3 If the second division is the same as the first, what is your preference? Do you want to register Competitor 3 for a third division? 3 Please select the third division: 3 If the third division is the same as one of the others, what is your preference? 3 Kata Competition 3 Kata Only - Form Select one Kata form only.
3 Kata Form Select one Kata form only.
3 Tori Name
3 Uke Name
Do you want to register Competitor 3 for a second kata? 3 Second Kata Form 3 Tori Name 2
3 Uke Name 2
Do you want to register Competitor 3 for a third kata? 3 Third Kata Form 3 Tori Name 3
3 Uke Name 3
Fourth Competitor 4 Competitor Name
First
Last
4 Date of Birth
Date Format: MM slash DD slash YYYY
4 Gender 4 Belt Color 4 Judo Affiliation 4 Please provide other affiliation and country
4 Judo Card Number
4 Judo Card Expiration Date
Date Format: MM slash DD slash YYYY
Does Competitor 4 require assistance or accommodation? 4 Please let us know what type of assistance or accommodation is requested, and/or provide the name of the person who will be assisting you.
Competitor 4 is competing in* 4 Waiver & Signature for Competitors 18 years of age & over WARNING!
4 Waiver & Signature of Minor's Parent/Guardian WARNING!
4 Shiai / Tournament Please select Competitor 4's division: Select one division only.
Do you want to register Competitor 4 for a second division? 4 Please select the second division: Select one division only.
4 If the second division is the same as the first, what is your preference? Do you want to register Competitor 4 for a third division? 4 Please select the third division: 4 If the third division is the same as one of the others, what is your preference? 4 Kata Competition 4 Kata Only - Form Select one Kata form only.
4 Kata Form Select one Kata form only.
4 Tori Name
4 Uke Name
Do you want to register Competitor 4 for a second kata? 4 Second Kata Form 4 Tori Name 2
4 Uke Name 2
Do you want to register Competitor 4 for a third kata? 4 Third Kata Form 4 Tori Name 3
4 Uke Name 3
Registration Total Total
$0.00
Name This field is for validation purposes and should be left unchanged.
