USA JUDO

2012 World Tour Online Entry Form

Please complete the form below.

The 'Send Email!' button will send a copy to USA Judo and the email address you have supplied.

Name of Athlete
Date Of Birth
Weight Division
Rank
Membership Expiration Date
Daytime Phone #
Email Address
Personal Coach of Record

Event 1	Camp: Yes No
Event 2	Camp: Yes No
Event 3	Camp: Yes No
Event 4	Camp: Yes No
Event 5	Camp: Yes No
Event 6	Camp: Yes No

Name as printed on credit card
Credit Card Type
Credit Card Number
Credit Card Security Code
Credit Card Expiration Date
Credit Card Billing Zip Code
Please agree to charges. I understand that there is a $100 non-refundable charge for EACH event selected above. This fee will reserve my position on the team and the $100 will be applied to the total cost for the event.
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