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Judo Registration Form
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Participant Information
Contact Email
*
Participant First Name
*
Participant Last Name
*
Participant Birthdate
*
- month -
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
- day -
1
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31
- year -
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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2004
2003
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2000
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1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
Participant Gender
*
Male
Female
Country
*
-- select country --
Canada
International
United States
Street Address (w/Apt#)
*
City
*
State
*
-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-- select province --
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
County
*
-- select county --
Autauga County
Baldwin County
Barbour County
Bibb County
Blount County
Bullock County
Butler County
Calhoun County
Chambers County
Cherokee County
Chilton County
Choctaw County
Clarke County
Clay County
Cleburne County
Coffee County
Colbert County
Conecuh County
Coosa County
Covington County
Crenshaw County
Cullman County
Dale County
Dallas County
DeKalb County
Elmore County
Escambia County
Etowah County
Fayette County
Franklin County
Geneva County
Greene County
Hale County
Henry County
Houston County
Jackson County
Jefferson County
Lamar County
Lauderdale County
Lawrence County
Lee County
Limestone County
Lowndes County
Macon County
Madison County
Marengo County
Marion County
Marshall County
Mobile County
Monroe County
Montgomery County
Morgan County
Perry County
Pickens County
Pike County
Randolph County
Russell County
Saint Clair County
Shelby County
Sumter County
Talladega County
Tallapoosa County
Tuscaloosa County
Walker County
Washington County
Wilcox County
Winston County
Zip Code
*
Phone
*
Would you like to
receive important event text alerts
on this number (eg. changes or delays)?
Emergency Contact Name
*
Emergency Phone
*
Which race or ethnicity best describes you?
*
American Indian or Alaskan Native
Asian
Pacific Islander
Black or African American
Hispanic / Latino
White / Caucasian
Multiple Ethnicities / Other
How did you hear about this year's Alabama State Games?
*
Student Ambassador
Teammate or Friend
ALAGAMES.COM
ASFFOUNDATION.COM
Social Media
Search Engine
Email
TV
Radio
Other
First and Last Name of the Student Ambassador.
*
Please be precise - this could help them win a SCHOLARSHIP!
Event Information
Age Division
*
Juniors (5-12)
Teens, Seniors, Veterans 1, Veterans 2 (13-50, 51+)
Juniors Breakdown
*
5-6
7-8
9-10
11-12
Age Breakdown
*
Teens 13-15
Teens 16-17
Seniors 18-29
Veterans 1 30-40
Veterans 2 41-50
51+
Juniors Weight Classes (including the Judo gi)
*
-- select one --
50lbs to 55lbs
56lbs to 60lbs
61lbs to 65lbs
66lbs to 70lbs
71lbs to 75lbs
76lbs to 80lbs
81lbs to 85lbs
86lbs to 90lbs
91lbs to 95lbs
96lbs to 100lbs
101lbs to 105lbs
106lbs to 110lbs
111lbs to 115lbs
116lbs to 120lbs
Weight will be taken before competition
Weight Classes (including the Judo gi)
*
-- select one --
101lbs to 105lbs
106lbs to 110lbs
111lbs to 115lbs
116lbs to 120lbs
121lbs to 130lbs
131lbs to 140lbs
141lbs to 150lbs
151lbs to 160lbs
161lbs to 170lbs
171lbs to 180lbs
181lbs to 190lbs
191lbs to 200lbs
201lbs to 210lbs
211lbs and up
Weight will be taken before competition
Experience/Belt Level
*
Novice- Judo White, Yellow, and Orange Belts
Intermediate- Judo Green Belts
Advanced- Judo Brown and Black Belts
Proof of Membership one of the Judo National Governing Bodies
Organization
*
USJA, USJF, ATJA, or USA Judo
Membership Number
*
Registered School
*
Certified Coach
*
Do you train in another martial art or any grappling style sport (including wrestling)?
*
Yes
No
What martial art?
*
Rank and Tenure?
*
Make a Donation
Adopt an Athlete
click here
, to learn more about this cause
Amount $
Waiver
*
I have read and agreed to the TERMS
*
Click here to view the TERMS
.
Is the participant 18 or older?
*
18 or older
Under 18
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian.
If registering a child under 18, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
Parent's signature
Payment Details
Discount or Tracking Code
Apply
Do not COPY & PASTE the code, please type it into this field.
Price
$
Discount (-)
$
Total
no handling
$
Handling
$
Donation
$
Total Owed
$
Payment Method
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Visa
Mastercard
Payable To:
Address:
click the "submit" button to submit your order then send a check to (or pay in person at) the address above.
1. Venmo the total amount to the Phone #:
2. Make sure you enter the code,
57279
in "What's it for".
3. Click the "pay now" button.
Enter a Check Number
Enter a Check Amount
Send email receipt to the participant
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