Ken Tamai Memorial Judo Championships Event Registration
Event Timing: Saturday, March 16, 2019
Event Address: DeMatha Catholic High School, 4318 Madison St, Hyattsville, MD 20781
Contact us at 703-622-6861 (Kevin), 301-537-5836 (Kurt)

* Required
Complete Entry Package Includes:

1. Entry form information (Google Forms or PDF Form)
2. Payment (Paypal, check via mail, check onsite, credit card onsite. NOTE: any onsite payments will be charged the late registration fees)
3. Signed Certificate Regarding Non--Black Belt Contestant(mail, text, or email) or email approval from your Sensei
4. Signed Waiver (mail, text, or email)
5. Copy of your USA Judo, USJA, USJF, or ATJA membership card (mail, text, or email)

Questions - Call or Send Text to Kevin Tamai at (703)622-6861
Send emails to huiosensei@gmail.com

Email address *
Name *
Your answer
Full Home Address *
Your answer
Contact phone number *
Your answer
Contestant Name (if different)
Your answer
Contestant Gender *
Contestant Age *
Your answer
Contestant Weight
Your answer
Contestant Date of birth *
MM
/
DD
/
YYYY
Judo Club *
Your answer
Rank (or color of belt) *
Your answer
National Organization Membership *
National Organization Membership Number *
Your answer
National Organization Membership Number Expire date *
Your answer
Competition Division *
Required
Declared Competition Division *
Your answer
Black belt certification *
Sensei Contact information (name, phone, email) *
Your answer
Kata Division (if applicable)
Kata Role (if applicable)
Assistance Needed or Required (if applicable)
Waiver Release of Liability - I, the applicant, state that I am 18 years of age or over and agree to release, waive, and discharge, to the greatest extent permitted bylaw, USA Judo from or for all claims demands and causes of actions or any other liabilities which may arise by virtue of injuries or damages caused in conjunction with or arising out of membership with USA Judo and the action or lack thereof of USA Judo and agree that I know and understand the risks involved in the sport of Judo/Jujitsu and do hereby assume these risks and accept the responsibility for any damages or injuries by engaging in the contact sport of Judo/Jujitsu. Please Print Name
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.