2019 SC State Champtionship Tournament Registration Form

 
 

* required field

 
 
 
 
Participant's Last Name:  *     
Participant's First Name:  *
 

 
Phone Number:  *     
Email:  *
 

 
Gender:  Female  Male *     
Birth Year:  *     
Rank:  *
 

 
Club:  *
Current Weight:  lbs    kg *   Click Here for weight classes by age.
 

 
Number of Divisions: Shiai:   *

 

 
 

 
Number of Divisions: Kata:   *

 

 
Membership: *
 I will bring a copy of my current membership to USJA, USA Judo, USJF, or ATJA/AJJF to Check In
 I do not remember my membership number or I will purchase or renew my membership at Check In

 

 
Waiver Upload: 
 

 
Payment Method: *
 I will pay early registration price online at www.SamuraiSlam.org BY 5/29/2019 (via PayPal) ($40/$10 first/second divisions)
 I will pay full price online at www.SamuraiSlam.org (via PayPal) ($50/$20 first/second divisions)
 I will pay full price at Check In on 6/8/2019
 Undecided
 I am a brown or black belt who would like to referee and compete (1 Free Division for Yourself)