FloridaInternationalUniversity Judo and Aikido Program

Presents

2nd Annual Southern Regional Judo Championships

Saturday – May 22, 2004

Pre-Registration Post marked before: (Saturday, May 17, 2004)

Weight-ins: 6:00 p.m. – 9:00 p.m. (Friday, May 21, 2004)

Registration: 10:00 a.m. – 9:00 p.m. (Friday, May 21, 2004)

Registration &Weight-ins MiamiAirport Marriott 1201 N.W. LeJeune Road,

Location: Miami, Florida

Venue Location: FloridaInternationalUniversity, Golden Panther Arena (GPA)

Miami, Florida33199

Entry Fee: $35.00 – Adults Late entry $ 50.00

$25.00 – Children 16 & under Late entry $ 40.00

* Make checks payable to: Judo Club at FIU Inc.

Divisions: Novice:Yonkyu & below, Advanced: Sankyu & Above

Juniors,Seniors, Masters & Team Challenge

Awards: Individual medals for 1st, 2nd and 3rd place

Team Trophies1st, 2nd, and 3rd place (Seniors & Juniors)

Men & Women Team Challenge Trophies 1st, 2nd 3rd Place

Opening Ceremonies: 9:00 a.m. Line -Up

Tournament Directors: Nestor Bustillo,Humberto Lopez,

Jack Williams, Ricardo Tuero

Head Referee: Hector Estevez

Membership:USJI / USJF / USJA Valid Current Card

Rules:IJF Modified Double Elimination / Round Robin

Sanctioned By:Florida Judo Incorporated - Sanction: # 0007-04

Sponsored By: FloridaInternationalUniversity Judo and Aikido Club

Miami-Dade College North Judo Club

Tamiami Judo and Aikido Club Inc.

Ricardo Tuero National Judo Institute, Inc.

2nd Annual Southern Regional Judo ChampionshipsSaturday – May 22, 2004

MaleFemale circle info: Junior Senior Master Novice Advanced

OFFICIAL ENTRY FORM

Last NameFirst NameM.I.

Date of BirthAgeM / F SexWeight
Home PhoneWork Phone E-Mail
Address
CityStateZip Code

Judo RankJudo Club

Judo Instructor Judo Instructor Rank
USJI / USJF Card NumberUSJA Card NumberFax / Cell / Work Phone

EMERGENCY CONTACT

Name
RelationPhone Number
DIVISIONS

The tournament directors reserves the right to deny any entry and/or

make changes in weight categories according to entries.

Junior Divisions
Boys: / Advanced
Novice / 5 – 6
Years old / 7 – 8
Years old / 9 – 10
Years old / 11 – 12
Years old / 13 – 14 Years old / 15 – 16 Years old
Girls: / Advanced
Novice / 5 – 6
Years old / 7 – 8
Years old / 9 – 10
Years old / 11 – 12 Years old / 13 – 14 Years old / 15 – 16 Years old
Senior Divisions
Male 55
Kilograms / M 60 Kilograms / M 66 Kilograms / M 73 Kilograms / M 81 Kilograms / M 90 Kilograms / M 100 Kilograms / M +100 Kilograms
Female 44
Kilograms / F 48 Kilograms / F 52 Kilograms / F 57 Kilograms / F 63 Kilograms / F 70 Kilograms / F 78 Kilograms / F +78 Kilograms

2nd Annual Southern Regional Judo ChampionshipsSaturday – May 22, 2004

!!!WARNING!!!

WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE

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 United States Judo Incorporated, United States Judo Federation, United States Judo Association, Florida Judo Incorporated, Florida International University, Florida International Judo and Self Defense Club, Judo club at FIU Inc.,Ricardo Tuero National Judo Institute Inc.,Tamiami Judo and Aikido Club Inc. , I hereby:

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

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

3. 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 to not only 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, permanent disability, or death.

5. Release, waive, discharge and covenant not to sue the United States Judo Incorporated, United States Judo Federation, United States Judo Association, Florida Judo Incorporated, Florida International University, Florida International Judo and Self Defense Club, Florida International Judo and Aikido Club, Judo club at FIU inc.Tamiami Judo Club, TRicardo Tuero National Judo Institute Inc. , aTamiami Judo and Aikido Club Inc, 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 to conduct 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 and 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 permitted by law.

I HAVE READ 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 THE RISK 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/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW.

Participant's Printed NameParticipant's SignatureDate

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE

(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as 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, 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 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/Guardian's Printed NameParent/Guardian's SignatureDate

2nd Annual Southern Regional Judo Championships Saturday – May 22,2004

Men’s & Women’s

Team Challenge Competition Information

5 Man Teams

55 kg & 60kg 66kg & 73kg 81kg & 90kg 100kg & 100+kg

#1 #2 #3 #4

Selection of the five-man team is as follows: You must select, at least one person from each weight group, but no more than two from each of the above groups. The teams will then be lined up from light to heavy for fight order. First three wins or best out of five.

*Note: Entry fee per Men Team $100.00

3 Women Teams

44kg & 48kg 52kg & 57kg LIGHT WEIGHT DIVISION

#1 L #2 L

63kg & 70kg 78kg & 78+kg HEAVY WEIGHT DIVISION

#1 H #2 H

Selection of the Three Women team is as follows: You must select, at least one person from each weight group, but no more than two from each of the above groups. The teams will then be lined up from light to heavy for fight order. First two wins or best out of three.

*Note: Entry fee per Women Team $60.00

Note: Awards for Men & Women Team Challenge: 1st, 2nd 3rd Place Trophies

All Team Challenge Subject to change

The tournament director/s reserves the right to deny any entry and/or make changes necessary without noticeto categories / teams as he thinks is the best interest of a fair tournament and the safety of all its participants

2nd Annual Southern Regional Judo Championships Saturday – May 22, 2004

Team Challenge Application Form MALE / FEMALE

*For women’s team please indicate light or heavy.

Please list below team members from the lightest to the heaviest and fight order:

1. ______

NameRankActual weight

2. ______

NameRankActual weight

3. ______

NameRankActual weight

4. ______

NameRankActual weight

5. ______

NameRankActual weight

Name of Team: ______Coach: ______

Club/ Dojo: ______Phone Contact: ( ) ____-______

5 Man Teams

55 kg & 60kg 66kg & 73kg 81kg & 90kg 100kg & 100+kg

#1 #2 #3 #4

Selection of the five-man team is as follows: You must select, at least one person from each weight group, but no more than two from each of the above groups. The teams will then be lined up from light to heavy for fight order. First three wins or best out of five.

3 Women Teams

44kg & 48kg 52kg & 57kg LIGHT WEIGHT DIVISION

#1 L #2 L

63kg & 70kg 78kg & 78+kg HEAVY WEIGHT DIVISION

#1 H #2 H

Selection of the Three Women team is as follows: You must select, at least one person from each weight group, but no more than two from each of the above groups. The teams will then be lined up from light to heavy for fight order. First two wins or best out of three.

*For women’s team please indicate light or heavy.

FloridaInternationalUniversity Judo AikidoProgram

Presents

2ndAnnual Southern Regional Judo Championships Saturday – May 22, 2004

Hotel Information

Miami Airport Marriott $ 95.00 + tax

Courtyard $ 85.00 + tax

Fairfield Inn $ 75.00 + tax

1201 N.W. LeJeune Road,

Miami, FL. 33126

All room rates include Continental Breakfast

(305) 649-5000 ask for the Judo rate

1-800-MARRIOTT

For any further Information Contact Nestor Bustillo @ 305-562-1854 or

Registration Information

Please send all the registration packets to the following address:

Note: Late entry if post-marked after: Saturday, May 17, 2004

Make checks payable to: Judo Club at FIU Inc.

C/0 Judo Club at FIU Inc

Nestor Bustillo

901 W. 80th Place

Hialeah, FL 33014

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