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Memorial Weekend Judo Camp
Please answer ALL the questions below.
You can provide payment and sign the official waivers once arriving to the camp.
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Email
*
Your email
First Name
*
Your answer
Last Name
Your answer
Your Phone Number
*
Your answer
Your Address
*
Your answer
Are you registering for the Advanced or Novice training?
*
Advanced
Novice
Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Weight (approximate)
*
Your answer
Which Organization are you a member of?
*
USA Judo
USJF
USJA
ATJA
Member Number
*
Your answer
Expiration Date
*
MM
/
DD
/
YYYY
Rank?
*
White
Yellow
Orange
Green
Blue
Purple
Brown
Black
Judo Club you are from?
*
Your answer
Parent/Guardian Name (put N/A if 18+)
*
Your answer
Parent/Guardian Contact # (put N/A if 18+)
*
Your answer
Emergency Contact Name (if same as parents put N/A)
*
Your answer
Emergency Contact Name (if same as parents put N/A)
*
Your answer
Has your coach/sensei determined that you are of sufficient skill level to participate in the Memorial Weekend Training Camp at the appropriate level that you have indicated above?
*
Yes
No
Name of your coach/sensei.
*
Your answer
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