Kohaku Shiai Bushido Challenge Registration
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Participant Name (first and last) *
Address *
Phone Number *
Email *
Birth Date *
MM
/
DD
/
YYYY
Age *
Gender *
Weight (lbs) *
Judo Rank *
Judo Belt Color *
Dojo Name *
Dojo Address *
Dojo Phone Number *
Sensei Name *
Dojo or Sensei Email *
Registered Organization Name
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Registered Organization Number (From ID Card)
How Many Total Divisions Would You Like to Compete In? (2 Division Limit. $25 for 1st Division, $15 for 2nd Division ADULTS ONLY FOR 2ND DIVISION) *
If Requesting to Compete in More than One Division, Would You Like to Compete in the Next Higher Weight Class if Available?
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