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    Registration Form

    Uploaded by

    mitch sawyer
    The document is a registration form for the Louisiana Brazilian Jiu Jitsu Federation competitions. It requests information such as name, address, date of birth, team name, and contact details. It lists the different divisions and age/weight classes competitors can register for, including Brazilian Jiu Jitsu, No-Gi, and Xtreme Youth Martial Arts. It includes a liability waiver and outlines the registration pricing for members and non-members. Payment can be made via PayPal or check to the Gracie Barra Northshore organization.

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    Registration Form

    Uploaded by

    mitch sawyer
    86 views2 pages
    The document is a registration form for the Louisiana Brazilian Jiu Jitsu Federation competitions. It requests information such as name, address, date of birth, team name, and contact details. It lists the different divisions and age/weight classes competitors can register for, including Brazilian Jiu Jitsu, No-Gi, and Xtreme Youth Martial Arts. It includes a liability waiver and outlines the registration pricing for members and non-members. Payment can be made via PayPal or check to the Gracie Barra Northshore organization.

    Original Title

    17230483 Registration Form[1]

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    The document is a registration form for the Louisiana Brazilian Jiu Jitsu Federation competitions. It requests information such as name, address, date of birth, team name, and contact details. It lists the different divisions and age/weight classes competitors can register for, including Brazilian Jiu Jitsu, No-Gi, and Xtreme Youth Martial Arts. It includes a liability waiver and outlines the registration pricing for members and non-members. Payment can be made via PayPal or check to the Gracie Barra Northshore organization.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    86 views2 pages

    Registration Form

    Uploaded by

    mitch sawyer
    The document is a registration form for the Louisiana Brazilian Jiu Jitsu Federation competitions. It requests information such as name, address, date of birth, team name, and contact details. It lists the different divisions and age/weight classes competitors can register for, including Brazilian Jiu Jitsu, No-Gi, and Xtreme Youth Martial Arts. It includes a liability waiver and outlines the registration pricing for members and non-members. Payment can be made via PayPal or check to the Gracie Barra Northshore organization.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Louisiana Brazilian Jiu Jitsu Federation www.LBJJF.com – info@lbjjf.

    com

    Registration Form for the Official LBJJF Competitions


    Name: Mitchell Sawyer_____Address:_5614 Kade Daniel Dr _______________________________________________

    City: Iowa__________________ State/Province: LA_____________________Zip Code: 70647___________

    Home Phone:337-377-6050______________ Date of Birth: 4/13/81_____________ Team Name: LABJJ___________

    E-mail: [email protected]___________________________________________________ Sex:_Male__________

    BRAZILIAN JIU JITSU DIVISIONS: Mark (X) Absolute( open weight)


    _______________BJJ Weight Classes: White Blue Purple Brown Black

    4-6yrs 7-9 yrs 10- 12yrs 13-15yrs Adult Master

    NO GI DIVISIONS: Mark (X) Absolute( open weight)


    _______________NO GI Weight Classes: Beginner Intermediate Advance

    4-6yrs 7-9 yrs 10- 12yrs 13-15yrs Adult Master

    Xtreme Youth Martial Arts: Mark (X)


    _______________Weight Classes: 7-9 yrs 10- 12yrs 13-15yrs 16-17 yrs

    TOURNAMENT RELEASE AND WAIVER: I understand the rules of the tournament and will abide by them. I understand that I am participating in a
    sport that has body contact and understand that injury can occur with my participation. I assume full responsibility for all of my actions during and
    connected to the above tournament. I understand the risk of competing in this form of Martial Arts competition and hereby release the event organizers
    and all of its employees and associates, tournament sponsors and the event facility, from any type of injury, loss, or death sustained while competing in this
    competition. I also state that I am in good physical condition and know of no reason why I cannot participate in this event. I have current and valid health
    insurance. I understand that The LBJJF LLC does not offer refunds and divisions or weight classes are subject to change. In case of an emergency, I hereby
    authorize any licensed medical personnel to perform any accepted medical procedure deemed necessary and I agree to bear the expense of any such
    treatment. I also agree that my attendance and/or performance at the tournament will be photographed, filmed, and/or taped and used exclusively by The
    LBJJF LLC for promotional or commercial purposes and I waive any compensation thereof. I agree to not use ANY footage obtained at the event for
    commercial purposes without expressed, written consent from The LBJJF LLC.. I have read the rules and release above and agree to all of its terms.
    Signed: _______________________________ Print Name:___________________________________ Date: _________

    PRICING:
    Brazilian Jiu Jitsu /No Gi
    Pre Registration (till one day before the event) $60

    Registration (day of the event)


    Member of LBJJF $60
    Non Member of LBJJF $80

    Xtreme Youth Martial Arts only : $60


    If you are fighting XYMA + BJJ/NoGi additional $20 on the BJJ/No Gi registration

    PO Box 2365 – Hammond, LA 70401– Phone: 985-605-3169 – Fax 985-520-0830


    Paypal [email protected] or write a check to Gracie Barra Northshore
    www.paypal.com
    Louisiana Brazilian Jiu Jitsu Federation www.LBJJF.com – [email protected]

    PO Box 2365 – Hammond, LA 70401– Phone: 985-605-3169 – Fax 985-520-0830


    Paypal [email protected] or write a check to Gracie Barra Northshore
    www.paypal.com

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