FEDERACIÓN VENEZOLANA DE JUDO (FEVEJUDO)
Parque Naciones Unidas, Centro Nacional de Judo, El Paraíso Caracas D.F
CARACAS, VENEZUELA
TELF: (58+416) 7056218
TELF-FAX  (58+212) 4711492 (58+261) 7575069
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CAMPEONATOS PANAMERICANOS DE JUDO SENIORS
Isla de Margarita, Venezuela
24 al 29 de Marzo del 2004

NUMERIC REGISTRATION

This form must be sent before March 15th, 2004

NATIONAL FEDERATION: __________________________________

Participating Crew

(     )

 

 

Not Participating Crew

(     )

 

 

 

 

 

 

Number of competitors:       

(    )                =

Male (        )

Female (        )

Number of coaches:

(           )

 

 

Number of referees:

(           )

 

 

Physicians:                                       

(           )

 

 

Others:

(           )

 

 

TOTAL:

(           )

 

 

Transportation medium:

By Air (           )           

By Land (             )

 


Signature:
______________________________
President of National Federation.

Pone Number: _______________________   

E-mail:________________________

Date:______________________

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FEDERACIÓN VENEZOLANA DE JUDO (FEVEJUDO)
Parque Naciones Unidas, Centro Nacional de Judo, El Paraíso Caracas D.F
CARACAS, VENEZUELA
TELF: (58+416) 7056218
TELF-FAX  (58+212) 4711492 (58+261) 7575069
-

venezuela.gif (24523 bytes)

CAMPEONATOS PANAMERICANOS DE JUDO SENIORS
Isla de Margarita, Venezuela
24 al 29 de Marzo del 2004

NOMINAL INSCRPTION, final.

This form must be sent before March 26th, 2004

NATIONAL FEDERATION OF: ______________________________

Cat.( M )   First Name and Last Name      Date of Birth                 Belt:                

-55 kg     _________________________       ________________        ____________

-60 kg     _________________________       ________________        ____________

-66 kg     _________________________       ________________        ____________

-73 kg     _________________________       ________________        ____________

-81 kg     _________________________       ________________        ____________

-90 kg     _________________________       ________________        ____________

-100 kg   _________________________       ________________        ____________

+100 kg  _________________________       ________________        ____________

Cat.( F )   First Name and Last Name       Date of Birth                 Belt:                

-44 kg     _________________________       ________________        ____________

-48 kg     _________________________       ________________        ____________

-52 kg     _________________________       ________________        ____________

-57 kg     _________________________       ________________        ____________

-63 kg     _________________________       ________________        ____________

-70 kg     _________________________       ________________        ____________

-78 kg     _________________________       ________________        ____________

+78 kg    _________________________       ________________        ____________

 Participating in the Team Competition: ___ Yes  ___ No Male:___   Female:___

Participating in the Kata Competition: 

Female: Nage No Kata_____ Katame no Kata ____  Ju No kata___

Male: Nage No Kata_____ Katame no Kata ______ Ju No kata_____

REFEREES:  (Show Classification)

------------------------------------------------- -------------------------------------------------

------------------------------------------------- -------------------------------------------------

Coaches:

------------------------------------------------- -------------------------------------------------

------------------------------------------------- -------------------------------------------------

Physician: --------------------------------- ------------------------------------------------

Delegates - Officials – Others ( Specify Function or Role)

--------------------------------------------- --------------------------------------------------

TOTAL PARTICIPANTS IN THE TEAM:__________________________

Seal and Signature of the President of National Federation :  ______________

COMISIÓN DE MEDIOS

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TODO EL CONTENIDO ES COPYRIGHT© UNIÓN PANAMERICANA DE JUDO 1998

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