MACHADO KIDS & ADULT FIRST TIMERS

STATE CHAMPIONSHIPS 17th MAY 2008 ENTRY FORM       BACK

NAME___________________________________________________D.O.B_____/____/____

ADDRESS____________________________________________________________________

_______________________________________________________POSTCODE____________

TELEPHONE ____________________________EMAIL________________________________

AFFILIATE ACADEMY____________________________________BELT__________________

TIME TRAINING________________________________WEIGHT________________________

Kids Divisions       

Age    4 - 6 Years       (   )    

          7 - 9 Years       (   )

          10 - 12 Years   (   )

          13 - 15 Years   (   )

          16 & 17 Years  (   )

 

Adult White Belt          (   )

Weight Categories

          Under20kg    (   )               56 - 60kg      (   )

          21 - 25kg      (   )               61 - 66 kg     (   )

          26 - 30kg      (   )               67 - 72 kg     (   )

          31 - 35kg      (   )               73 - 79 kg     (   )

          36 - 40kg      (   )               79 - 85 kg     (   )

          41 - 45kg      (   )               85 - 91 kg     (   )

          46 - 50 kg     (   )               91 - 97 kg     (   )

          51 - 55kg      (   )               Over 97 kg    (   )

Competitor Entry Fee

Kids & Adults $30

ALL FORMS TO BE COMPLETED AND POSTED TO ADDRESS

BELOW BEFORE 15TH MAY

 Signature___________________________________Date_____________

Guardian______________________________Witness________________