Formatos Carnet y Grado Dan Campeonato Panamericano y Sudamericano Juvenil de Judo 2004

FEDERACIÓN PUERTORRIQUEÑA DE JUDO
Dirección: A-C Comité Olímpico Apartado 8 San Juan, Puerto Rico 00902
Telefax (787) 723-3890 - Fax: (787) 723-5558 Celular 787-548-0039
E-mail: ippon1@coqui.net

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This schedule should be presented to obtain the PJU Identification card, before the technical congress and draw, for all the delegations without exception:

UNIÓN PANAMERICANA DE JUDO		UNIÃO PANAMERICANA DE JUDÔ
PANAMERICAN JUDO UNION		UNION PANAMERICAINE DE JUDO

APPLICATION OF MEMBERSHIP AND CERTIFIED GRADE (DAN)

National Federation: ____________________

Picture N°:_________

For exclusive use of the PJU

Certificate No. _________________ Book No. ______________________

Date: _______________________________________________________

Name :________________________________________________________________________

Last Name: ____________________________________________________________________

Birthplace: _________________________________ Citizenship:______________________

Date of Birth: dd/mm/yyyy:______/_____/___________ Bleed Group:___________________

ID Card No. ________________________ (Passport)________________

Dirección Habitación:__________________________________E-mail:__________________________

Country: _________________________ Telephone: _____________ Profession:__________________

Instructions Grade: ________________Idioms: English: ___ Espanish: ___ Frenchs: ___ Portugues ____

Dan in Judo: __________________________ (it Indicates their grade in numbers (1ro, 2 do, 3 ero etc., if it is not Dan grade, please indicate the color of their belt).

Date of Obtaining of their I finish Dan grade or belt color: ____/_____/______(dd/mm/yyyy)

Year of Entrance to Judo: _______ Competitor_______ No competitor_________

Funtion: Competitor:______, Official:_______, Referee_______, Coach:_______, Doctor______President of the NF:______ General Secretary of the NF:________

__________________________
Signature of the President National Judo Federation
( Stick of the National Federation)

PANAMERICAN JUVENILE AND JUNIOR CHAMPIONSHIPS
Carolina, Puerto Rico
March 24th - 29th, 2004

_________________________
Signature of the Solicitors

_________________________
Signature of the PJU Education Director (PJU Stick)

PANAMERICAN JUVENILE AND JUNIOR CHAMPIONSHIPS Carolina, Puerto Rico March 24th - 29th, 2004

_________________________ Signature of the Solicitors

_________________________ Signature of the PJU Education Director (PJU Stick)

PANAMERICAN JUVENILE AND JUNIOR CHAMPIONSHIPS
Carolina, Puerto Rico
March 24th - 29th, 2004

_________________________
Signature of the Solicitors

_________________________
Signature of the PJU Education Director (PJU Stick)