Formatos V Campeonato Panamericano Infantil de Judo 2005

V PANAMERICAN INFANTILE JUDO CHAMPIONSHIP
09th to 14th, NOVEMBER 2004
SAN JOSE, COSTA RICA

MALE: (INFANTILE 13 A 14 YEARS OLD ) (Born in 1991, 1992)
Number	Category	Last name and Name	Date of Birdth
1	-36 Kg.
2	-40 Kg.
3	-44 Kg.
4	-48 Kg.
5	-53 Kg.
6	-58 Kg.
7	-64 Kg.
8	+64 Kg.
FEMALE: (INFANTILE 11 A 12 YEARS OLD ) (Born in 1991, 1992)
Number	Category	Last name and Name	Date of Birdth
1	-36 Kg.
2	-40 Kg.
3	-44 Kg.
4	-48 Kg.
5	-53 Kg.
6	-58 Kg.
7	-64 Kg.
8	+64 Kg.

President Signature of the national judo federation:______________________________

¡2004 Annual Membership and Dan Grade Form¡

(How to get the 2004 PJU Annual Membership Card)

This form must be hand in before the Technical Congress by all Federations, with no exceptions, in order to get the PJU Card:

Annual Membership and Dan Grade Form

PJU:______ IJF:___

National Federation: ____________________

Photo No._________

For PJU Use Only

Certificate No. _________________ Book No. ______________________

Date: _______________________________________________________

Date of Form Issuance: Day________ Month_____________ Year_______ Please print or write down in clear and esay to understand hand writing. Remember that this is the data that will appear in your Memebership Card and Diplomas.

Name (Only one name allowed):____________________________________________

Last Name(Only one last name allowed):______________________________________

Place of birth: ______________________ Nationality:___________________________

Date of Birth: dd/mm/yyyy:______/_____/________ Blood Type:__________________

ID Number ___________________ (Passport)_____________ (C.I)_____________

Room Number:______________________________E-mail:_________________

Country: _________________________ Phone: _____________

Proffession:__________Academic Level in Education:________

Languages you speak: English: ____ Spanish:_____French:____Portuguese ____

Belt in Judo: __________________________ (please specify your black belt grade in numbers : 1st, 2 nd, 3 rd etc., if you are not a black belt, please specify the color of your belt). Last Date you got your Belt Recognition: ___/___/____(dd/mm/yyyy)

Year when he started Judo: _______ Competitor_______ No competidor_________

Role: Competitor:______, Official:_______, Referee_______, Coach:_______,

Physician______President of NF:______ NF General Secretary:________

_____________________________________

President of Federation
(Seal of Federation and Signature of the President)

________________

Applicant’s Signature

______________________

PJU Director Signature (PJU Seal)

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

MALE: (INFANTILE 11 A 12 YEARS OLD ) (Born in 1993 y 1994)
Number	Category	Last name and Name	Date of Birdth
1	-28 Kg.
2	-31 Kg.
3	-34 Kg.
4	-38 Kg.
5	-42 Kg.
6	-48 Kg.
7	-53 Kg.
8	+53 Kg.
FEMALE: (INFANTILE 11 A 12 YEARS OLD ) (Born in 1993 y 1994)
Number	Category	Last name and Name	Date of Birdth
1	-28 Kg.
2	-31 Kg.
3	-34Kg.
4	-38 Kg.
5	-42 Kg.
6	-48 Kg.
7	-53 Kg.
8	+53 Kg.