UNIÓN PANAMERICANA DE JUDO

UNIÃO PANAMERICANA DE JUDÔ

PANAMERICAN JUDO UNION

UNION PANAMERICAINE DE JUDO


 

VIII PANAMERICAN INFANTILE JUDO CHAMPIONSHIPS
III Caribbean Judo Championships

Santo Domingo, Republica Dominicana
December, 05 to 08, 2008

 

 ¡ NUMERIC INSCRIPTION ¡
Will have to be send before November 10, 2008

NATIONAL FEDERATION: __________________________________

To Participate  (     )    
Not Participate (     )    
Number of Competitors: (           )        = Male   ) Female (           )
Number of Coach (           )        = Male   ) Female (           )
Number of Referee    (           )        = Male   ) Female (           )
Doctors:                                             (           )        = Male   ) Female (           )
Others: (           )        = Male   ) Female (           )
TOTAL: (           )        = Male   ) Female (           )
Transportation:  By   Air (           )    By earth (          )

Signature:____________________________
National President Federation

Phone: _______________________

Date: _________________________


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VIII PANAMERICAN INFANTILE JUDO CHAMPIONSHIPS
III Caribbean Judo Championships

Santo Domingo, Republica Dominicana
December, 05 to 08, 2008


NOMINAL
INSCRIPTION , final.
Will have to be send before October 27, 2008

NATIONAL FEDERATION: _________________________________________

                                                            (SHIAI)

MALE: (INFANTILE 11 A 12 YEARS OLD ) (Born in 1996 y 1997)

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

-47 Kg.

   

7

-52 Kg.

   

8

+52 Kg.

   

FEMALE: (INFANTILE 11 A 12 YEARS OLD ) (Born in 1996 y 1997)

Number Category Last name and Name Date of Birdth

1

-28 Kg.

   

2

-31 Kg.

   

3

-34Kg.

   

4

-38 Kg.

   

5

-42 Kg.

   

6

-47 Kg.

   

7

-52 Kg.

   

8

+52 Kg.

   

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MALE: (INFANTILE 13 and 14 YEARS OLD ) (Born in 1994, 1995)

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 13 and 14 YEARS OLD ) (Born in 1994, 1995)

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.

   

Official: (Referee, Coach, Doctor and Other)

  Name Name Name
REFEREE:      
COACH:      
DOCTORS      
OTHERS      
TOTAL MEMBERS OF THE NATIONAL TEAM      

President  Signature of the national judo federation:______________________________

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¡2008 Annual Membership and Dan Grade Form¡

(How to get the 2008 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)

COMISIÓN DE MEDIOS

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