9th Annual Grassroots Judo™ Junior, Youth, Team, & Kata National Championships Page 9 of 23

2018 USJF / USJA Junior National Judo Championship Team Application

Yudanshakai (Print Name) _ _ MALE TEAM FEMALE TEAM Total Amount Enclosed: Yudanshakai Representative

Print Name _ _ Signature _ Date:

Phone: (_ ) _ _ ____ Email:

Pre-registration Fee: $150 per team if postmarked no later than Friday, June 1, 2018 Late-registration Fee: $175 per team if postmarked from June 2 to June 22, 2018

Walk-Up Fee: $200 per team on Friday, July 6, 2018

MAKE ALL CHECKS PAYABLE TO: Konan Judo Association - Please note in Memo 2018 USJF / USJA SUMMER Nationals

MAIL Entry and Check TO: 2018 SUMMER Nationals, 5091 Streamside Ct NE, Rockford, MI 49341