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12 th Annual Creepy Crawly NeWaza Tournament – Sanction #12454 12 th Annual Creepy Crawly NeWaza Tournament October 14, 2017 King's Way Ministry’s Gym 10126 E Eagle River Loop Rd, Eagle River, AK 99577 Hosted by: UAA Judo and Jiu Jitsu Greatland Martial Arts Sanctioned by: USA Judo Sanction number 12454 Tournament Director: Sensei Trevor Martin Head Referee Sensei Jacob Dempsey

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  • 12th Annual Creepy Crawly NeWaza Tournament – Sanction #12454

    12th Annual Creepy Crawly NeWaza

    Tournament October 14, 2017

    King's Way Ministry’s Gym

    10126 E Eagle River Loop Rd, Eagle River, AK 99577

    Hosted by:

    UAA Judo and Jiu Jitsu

    Greatland Martial Arts

    Sanctioned by:

    USA Judo

    Sanction number

    12454

    Tournament Director:

    Sensei Trevor Martin

    Head Referee

    Sensei Jacob Dempsey

  • 12th Annual Creepy Crawly NeWaza Tournament – Sanction #12454

    EVENTS SCHEDULE REGISTRATION DEADLINE 9:00 pm Wednesday October 11th Register On-line at https://www.alaskajudo.org/12th-annual-creepy-crawly-newaza-tournament/, or fill out the attached entry form. Entry forms with payment should be given to your instructor if they are collecting them to turn in as a club, or delivered to at Greatland Martial Arts, 520 W. 58th Ave. Anchorage AK 99518. (Instructors, email a list of the registrants you have collected form for to [email protected]) Competitor information (name, sex, date of birth, weight, and club) must be submitted to [email protected] by this time. Contestant’s weights will be verified prior to the contestant’s division. Contestant’s failing to be under the maximum weight or age for their declared division, or of the incorrect gender, will be dropped from the division without a refund. Contestants may move up age and weight categories if they choose with the consent of coach and parent if the contestant is a minor. LATE REGISTRATION DEADLINE 12:00 pm (noon) Friday October 13th Late registration will be subject to a $20 late fee. MAT SET-UP 8:30 pm Friday October 13th WEIGHT & GI CHECK October 14th prior to the start of each division BRACKETING COMMITTEE October 13th Brackets will be posted on-line, and hung up at the

    tournament site for review (contestants registering late will be place in an existing bracket, unless it benefits contestants who were pre-registered)

    REFEREE AND OFFICIAL MEETING October 14th 9:00 am This will focus the rules of this tournament, coaches and players are welcome to attend. Certified referees and referees in training approved by the head referees or tournament director may officiate at this tournament.

    COMPETITION SCHEDULE SATURDAY OCTOBER 14TH Contestant Check in and Bracket Check 9:00-10:00 am Competition Begins 10:30 am (Opening Ceremonies) Bracket order will be set during the competition with the goal of making sure competitors are only competing in one division at a time. It is noted, that this goal may not always be achieve able. However, a contestant will not be required to forfeit a match while actively competing on another mat. Award Presentation Following the completion of each division

    https://www.alaskajudo.org/12th-annual-creepy-crawly-newaza-tournament/mailto:[email protected]:[email protected]

  • 12th Annual Creepy Crawly NeWaza Tournament – Sanction #12454

    JUDO AND JIU JITSU RULES 2016 International Judo Federation and current International Brazilian Jiu Jitsu Federation Contest Rules will be used, as modified below:

    1. The judo divisions are mat-work only. No throws will be scored and more time will be allotted to mat-work. If a competitor comes to their feet to execute a take down, the contestants may be restarted from a neutral position.

    2. All submissions must be applied with control in such a way as to allow your opponent the opportunity to submit either by tapping or calling out. Failing to do so will result in immediate disqualification. If the referee and tournament officials believes the action to have been intentional the player will be disqualified from the tournament.

    3. A competitor may ask for a medic without losing the match; and a medic may ask to examine a competitor without the competitor losing the match. However, if the medic determines a competitor is not fit to continue competition, the competitor is out of the competition, and may only re-enter with the consent of the medic.

    4. Contestants turning 5 years old in 2017 and older will be allowed to participate.

    5. Co-ed competition will be allowed in this tournament for U11 and under only if there are not enough participants to fill a division.

    6. A 3-minute rest period will be permitted between back to back matches for matches in the same division or matches in Judo and Jiu Jitsu divisions. When competing in more than one division in the same art, back to back matches not in the same division will not require a rest period. The competitor has the right to waive the rest period.

    7. Scoring will be double elimination. The winner may have lost once; all other contestants will have lost twice.

    8. The competition area will be approximately 24’x24’ (twenty-four feet by twenty-four feet) with a 12’ (twelve foot) safety zone.

    9. The following table list the modifications for techniques allowed by division.

    U13 and below U15 and U17 Senior/Masters Beginning Interm. / adv. Beginning Interm. / adv. Beginning Interm. / adv.

    Submissions Judo Jiu

    Jitsu Judo Jiu

    Jitsu Judo Jiu

    Jitsu Judo Jiu

    Jitsu Judo Jiu

    Jitsu Judo Jiu

    Jitsu strangulations / chokes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Joint locks No No No Yes No Yes No Yes No Yes No Yes Shoulder locks No No No No No No No No No No No Yes Guillotine with neck crank No No No No No No No No No No No Yes Cervical Lock No No No No No No No No No No No No Neck Cranks No No No No No No No No No No No No Wrist Locks No No No No No No No No No No No Yes Straight Foot Lock No No No No No No No No No No No Yes Toe Hold No No No No No No No No No No No No Knee Bar No No No No No No No No No No No No Heel Hook No No No No No No No No No No No No Muscle Crusher No No No No No No No No No No No No

    Note: Entangled arm locks, Ude Garami (Americana) and Ushiro Ude Garami (Kimura) are designed to attack the elbow when properly applied, and will be permitted unless the attacker is modifying them to explicitly attack the shoulder joint.

  • 12th Annual Creepy Crawly NeWaza Tournament – Sanction #12454

    10. Prohibited Throwing Techniques 1. All throws which cause the uke (the receiver of the technique) to land on their head or neck. 2. All throws in which tori (the executer of the technique) throws in such a way as to land on his or her own head. 3. All throws executed while applying a submission technique. 4. Kani Basami (Crab Scissors). 5. Kawasu Gake (Entangled Leg Throw) 6. Kata Garuma (Shoulder Wheel / Fireman’s Carry) thrown to the rear. 7. Supplex 8. Dake Age (Holding Separation, slamming your opponent when they pull guard)

    Contest Divisions

    There will be beginning as well as Intermediate/Advanced divisions for both Judo and Jiu Jitsu. If there are not enough players to fill a division, the players in the division may, with the permission of the tournament director, their coach, and parent or legal guardian if the player is a minor:

    1. Withdraw from the tournament and receive a refund of entry fees. 2. Move to an older (younger for Masters), heavier, or more advanced division. The contestant will then play by

    the rules of the division they move into. The contestant will NOT be permitted to move to a younger (except for Masters), lighter, or less experienced division.

    3. An exhibition division may be created.

    Beginning divisions are intended for players with less than one year of experience, or less than 3 competitions, under the rules of the given art (Judo or Jiu Jitsu) (e.g. a competitor may compete in the intermediate/advanced Jiu Jitsu and still compete in the beginning Judo or vice versa). Minors may elect to compete in a beginning division for safety reasons if there is a difference in permitted techniques between the beginning and intermediate/advanced divisions.

    Players may compete in more than one division, and are encouraged to compete in both Judo and Jiu Jitsu divisions.

    For Junior divisions (U7 through U17) contestants must be born in the years specified or younger. Juniors may play in the Senior divisions with the appropriate waiver signed by themselves, their parents, their coach, and approved by the tournament director. For Masters divisions, contestants must be the minimum age or older.

    U7 - Bantam 1 (Born in 2011-2012) Seniors (Born 1999 and earlier) -46lbs; -55lbs; 55+lbs (female) -121lbs; -145lbs; -154lbs; -172lbs; 172+lbs U9 - Bantam 2 (Born in 2009-2010) (male) -132lbs; -161lbs; -198lbs; -220lbs; 220+lbs -55lbs; -66lbs; 66+lbs U11 - Intermediate 1 (Born in 2007-2008) Masters 35+ - born 1982 or earlier -70lbs; -81lbs; -95lbs; 95+lbs Brackets will be made according to the number of entries U13 - Intermediate 2 (Born in 2005-2006) Masters 50+ - born 1967 or earlier -75lbs; -92lbs; -114lbs; 114+lbs Brackets will be made according to the number of entries U15 - Juvenile A (Born in 2003-2004)

    -88lbs; -106lbs; -128lbs; -141lbs, 141+ U18 - Juvenile B (Born in 2000-2002) (Female) -97lbs; -114lbs; -139lbs; -154lbs; 154+lbs (Male) -121lbs; -145lbs; -178lbs; -198lbs; 198+lbs

  • 12th Annual Creepy Crawly NeWaza Tournament – Sanction #12454

    NOTICE TO ALL CLUBS Routing of Tournament Documents In order to ensure that tournament documents are not lost nor misplaced, please follow these instructions:

    COMPETITION ENTRY FORMS AND WAIVERS: Check to be certain all entry forms have been signed by the coach, competitor, and the competitor’s parents the competitor is a minor. The WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE must be signed by all required parties and the waiver for minors playing in a senior division must be signed by the competitor, the competitor’s parent or legal guardian, the competitor’s coach, and be approved by tournament director; failure to do so may result in elimination of the competitor from the competition. All entry forms and fees are due by 10:00 AM Saturday Oct. 14, 2017. Registration information is due by the registration dates (9:00 PM Wednesday October 11th and late registration (additional $20 fee) by 12:00 PM (noon) Friday October 13th) REGISTRATION: Register on-line at https://www.alaskajudo.org/12th-annual-creepy-crawly-newaza-tournament/. If you are unable to register on-line, Please send registration information to [email protected] NO LATER THAN October 11th (October 13th for late registration), 2017. (Coaches may collect forms and fees, and email registrant information. Coaches who collect forms and fees are then responsible for delivering the forms and fees to the tournament director prior to the tournament.) When emailing the registration information, include the competitors first and last name, club, sex, weight, and date of birth, and the division(s) the competitor will be competing in. ENTRY FEES: $30 and $10 per additional division for the first competitor per family $20 and $10 per additional division for the second competitor per family $10 and $10 per additional division for each additional family member per family LATE ENTRY FEES: Same as above plus an additional $20 per contestant registering late Make Checks Payable to UAA Judo and Jiu Jitsu

    NO ENTRIES WILL BE ACCEPTED AFTER October 13 2017 12:00 PM (noon). There will be a $20 late fee for applicants not registered by 9:00 PM Wednesday October 11th.

    ELIGIBILITY: Age cut-off date: Dec 31, 2017.

    https://www.alaskajudo.org/12th-annual-creepy-crawly-newaza-tournament/mailto:[email protected]

  • 12th Annual Creepy Crawly NeWaza Tournament – Sanction #12454

    2nd Annual Judo and Jiu Jitsu Tournament Sanction # 12454

    Male: ___ Female: ___ Date of Birth: _________ Weight: ______ ______ Rank: _____________ If competing in more than one division, please note which divisions: ________________________________________ Name: _____________________________________ Club: ________________________________________ Address: ___________________________________ Phone: ________________________________________ Email Address: _____________________________ mailing lists: Judoka Referee Club List If you want your email address added to a list, you must check its check box.

    Divisions Judo Jiu Jitsu

    _____________________________________________ _____________________________________________ _____________________________________________

    _____________________________________________ _____________________________________________ _____________________________________________

    Judo Membership: USA Judo – Judo USA Judo – Jujitsu USA Judo – Dual Judo and Jujitsu USJF USJA Membership(s) #: _______________________________ Exp. Date(s): ___________________________________ Note: Registration with USA Judo - Judo, USJF, or USJA is required for Judo divisions, and USA Judo – Jujitsu for Jiu Jitsu divisions.

    If assistance/accommodation is needed (check the appropriate box): □Vision Loss/Blindness □Hearing Loss/Deafness Type of assistance/accommodation requested or name of person assisting: _______________________________________

    Certificate Regarding Non-Black Belt Contestants I _________________________ a Judo/Jiu Jitsu instructor, who has been awarded the rank of Shodan (Black belt) or higher or who is a certified coach or instructor, hereby certify that, ________________________________ although not having been awarded the rank of Shodan (black belt) or higher, is of sufficient aptitude and skill in Judo / Jiu Jitsu to compete safely in this competition. Coach / Instructor (print) ____________________________________________ Coach / Instructor Signature ____________________________________________ Date ___________ Rank __________________ Organization rank was obtained through __________________________________________

    Parent / Legal Guardian Consent for Competitors under 18 Years of Age I, the undersigned parent or legal guardian of the named contestant, ___________________________________, understands the method of competition for this competition. Including contested weight categories and possible changes deemed necessary by the Tournament Director for the safety of the sport and competitors involved. I have agreed to allow my child to participate in this event. Parent/Guardian: ___________________________________________ Date: ____________________ Location: Greatland Martial Arts – Eagle River () DEADLINE for REGISTRATION: October 11, 2017 9:00 p.m. DEADLINE for LATE REGISTRATION: October 13, 2017 noon WEIGH IN: October 14, 2017 Weight checks prior to each division COMPETITION: October 14, 2017 Starting at 10:30 a.m. Sanctioning Body: USA Judo THE RELEASE AND WAIVER FOLLOWING THIS FORM MUST BE CAREFULLY REVIEWED AND SIGNED BY THE PARTICIPANT AND THEIR PARENT(S) OR GUARDIAN(S), IF THE PARTICIPANT IS A MINOR. FAILURE TO SIGN THE WAIVER WILL RESULT IN ELIMINATION FROM THE TOURNAMENT.

    WARNING!

  • WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE

    (Including Limited Co-Ed Competition for Age 10 and Under)

    In consideration of being permitted to participate in any way, including travel to and from, in any Judo/Jiu Jitsu tournament, practice, clinic,

    and related events and activities (“Activity”) of the USA Judo/United States Judo, Inc., United States Judo Federation, Inc., United

    States Judo Association, Inc., Alaska Judo, Inc., UAA Judo and Jiu Jitsu Club, Greatland Martial Arts, and the University of

    Alaska Anchorage, I agree:

    1. I understand the nature of Judo/Jiu Jitsu activities and believe I am qualified to participate in such Activity. I also understand the rules

    governing the sports of Judo and Jiu Jitsu according the divisions I am competing in.

    2. I further acknowledge that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions, and the

    elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my

    coach, supervisor, and/or a tournament official of such conditions and refuse to participate.

    3. I acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, illness or disease,

    including permanent disability or death, and severe social and economic losses due not only to my own actions, inactions or

    negligence, but also to the actions, inactions, or negligence of others, the rules of the sport of Judo, or conditions of the premises or of

    any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time.

    4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following

    such injury, illness, disease, permanent disability, or death.

    5. I hereby release, waive, discharge and covenant not to sue the USA Judo/United States Judo, Inc., United States Judo Federation,

    Inc., United States Judo Association, Inc., Alaska Judo, Inc., UAA Judo and Jiu Jitsu Club, Greatland Martial Arts, and the

    University of Alaska Anchorage, together with their affiliated clubs, their respective administrators, directors, officers, agents,

    coaches, and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents,

    legal guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of

    premises used in conducting the event, all of whom are hereinafter referred to as "Releasees", from any and all litigation expenses,

    attorney fees, loss, liability, damage or costs on account of injury, illness, disease, including permanent disability and death or damage

    to property, caused or alleged to be caused in whole or in part by the negligent acts or omissions of the Releasees or otherwise to the

    fullest extent permitted by law.

    I HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL

    RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY AND WITHOUT ANY INDUCEMENT OR

    ASSURANCE OF ANY NATURE. CONSISTENT WITH THE BY-LAWS OF USJF, THIS TOURNAMENT MAY INCLUDE CO-ED

    COMPETITION FOR AGES 10 AND UNDER IN COMPARABLE AGE/WEIGHT DIVISIONS WHERE THERE IS AN

    INSUFFICIENT NUMBER OF GIRLS FOR NON-CO-ED AGE/WEIGHT DIVISIONS. I HAVE READ AND UNDERSTAND THE

    TOURNAMENT ANNOUNCEMENT CONCERNING THESE SPECIAL DIVISIONS. I AGREE TO PARTICIPATE KNOWING THE

    RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18

    YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY

    PARENT/LEGAL GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW. I INTEND THIS TO BE A COMPLETE AND

    UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF

    ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDING SHALL

    CONTINUE IN FULL FORCE AND EFFECT.

    __________________________________ ______________________________ _________________

    Participant Participant’s Signature Date

    FOR PARENTS/LEGAL GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)

    This is to certify that I, as parent/legal guardian with legal responsibility for this participant, do consent and agree to his/her release, as

    provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless

    the Releasees from any and all liabilities incident to my minor child’s involvement or participation including litigation expenses, attorney

    fees, loss, liability, damage or costs which may incur as the result of the minor child’s participation in these programs as provided above,

    even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings

    and conditions and their ramifications.

    __________________________________ ______________________________ _________________

    Parent/Legal Guardian Parent/Legal Guardian’s Signature Date

    CERTIFICATE REGARDING JUNIOR AGE CONTESTANT'S ATHLETIC, TECHNICAL KNOWLEDGE AND

  • ABILITY TO COMPETE IN SENIOR DIVISION COMPETITION

    To be completed for contestants under 18 competing in a Senior Division.

    Name of Competitor: __________________________________ Age: _________

    I certify that I am a Judo/Jiu Jitsu instructor holding the rank of Shodan (Black Belt) or higher, or a certified coach which has been awarded by a

    recognized national governing body for Judo or Jiu Jitsu. I further certify that the above named junior competitor is currently a student under my

    instruction, and that this competitor has sufficient athletic skill, technical knowledge, and skill in Judo/Jiu Jitsu to SAFELY compete in a Senior Division.

    I certify that the age reported above is accurate for this competitor on the date of the tournament.

    Instructor: Date:

    WARNING!

    WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE AS A JUNIOR CONTESTANT IN

    A SENIOR DIVISION

    In consideration of being permitted to participate in any way, including travel to and from, in any Judo tournament, practice, clinic, and

    related events and activities of the USA Judo/United States Judo, Inc., United States Judo Federation, Inc., United States Judo

    Association, Inc., Alaska Judo, Inc., Alaska Brazilian Jiu Jitsu Federation, UAA Judo and Jiu Jitsu Club, Greatland Martial Arts,

    and the University of Alaska Anchorage, I hereby:

    1. Acknowledge that I am familiar with the sport of Judo and understand the rules governing the sport of Judo.

    2. Acknowledge that the senior division competition matches students 17 years and older attending the tournament that choose to participate in the senior

    division competition, by sex and weight classes. Weight classes used are noted in the Rules. The actual weights of the competitors within a division may

    vary considerably depending on the number of competitors available.

    3. Agree that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions, and the elimination or scoring system to be

    used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach or supervisor of such condition(s) and refuse to

    participate.

    4. Acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, including permanent disability or death,

    and severe social and economic losses due not only to my own action, inaction or negligence, but also to the action, inaction, or negligence of others, the

    rules of the sport of Judo, or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me or

    not reasonably foreseeable at this time.

    5. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following such

    injury, permanent disability, or death.

    6. Release, waive, discharge and covenant not to sue the USA Judo/United States Judo, Inc., United States Judo Federation, Inc., United States Judo

    Association, Inc., Alaska Judo, Inc., Alaska State Brazilian Jiu Jitsu Federation, UAA Judo and Jiu Jitsu Club, Greatland Martial Arts, and the

    University of Alaska Anchorage, together with their affiliated clubs, their respective administrators, directors, agents, coaches, and other employees or

    volunteers of the organization, event officials, medical personnel, other participants, their parents, guardians, supervisors and coaches, sponsoring agencies,

    sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used in conducting the event, all of whom are hereinafter referred to as

    “releasee", from any and all claims, demands losses, or damages on account of injury, including permanent disability and death or damage to property,

    caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise to the fullest extent of the law.

    7. Parents or legal guardians of minor participants (age 17 and below) acknowledge that their legal dependent is, upon the recommendation of his/her

    Judo/Jiu Jitsu instructor (or coach), capable of competing against other Judo/Jiu Jitsu competitors in the senior division competition regardless of

    differences in age or rank.

    I HAVE READ TO THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY

    SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING TO THE RISKS AND CONDITIONS

    INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL.

    __________________________________ ______________________________ _________________

    Participant Participant’s Signature Date

    FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)

    This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided

    above, of all the Releasees, and, for myself, my heirs, my assigns, and next of kin, I release and agree to indemnify and hold harmless the

    Releasees from any and all liabilities incident to my minor child’s participation in these programs as provided above, even if arising from

    their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and

    their ramifications.

    I HAVE READ TO THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY

    SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING TO THE RISKS AND CONDITIONS

    INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL.

    __________________________________ ______________________________ _________________

    Parent/Guardian (please print name) Parent/Guardian’s Signature Date

    Events ScheduleCompetition Schedule Saturday October 14thJUDO AND JIU JITSU RULESContest Divisions

    Group1: OffDate of Birth: Weight: Rank: Club: Address: Phone: Check Box9: OffCheck Box10: OffCheck Box11: OffDivision1: Division2: Division3: Division4: Division5: Division6: MemNum: ExpDate: Check Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffCheck Boxb: OffCheck Boxh: OffAssist: Contestant: Coach: CoachR: Organization: Date1: Email: Date2: Date3: Date4: Date5: Parent: Date6: