Convention Registration Form Convention Registration 2023 Hotel reservations: Call 916-446-0100 and mention "AJJF National Convention 2023" for group rate & give them block code AJJ to reserve your room. Registrant Information Name * First Last * Last Dojo Name Email * Phone Number Age * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Registration is for * Adult/Teen (age 14 or older) Junior (age 13 or younger) Extras only To register an individual, select age group; to purchase *only* extra t-shirts, meal tickets, freestyle contest entry or other items, select 'Extras only'. AJJF Membership Current AJJF membership required for all participants. Membership cards of AJJF and ATJA are accepted. If you are regularly attending classes at an AJJF school, please make sure your AJJF membership is current through Convention weekend. If needed, please link to AJJF New Members and Renewals to sign up or renew. If you are not an AJJF regular, you may participate with for a $5 event fee. Membership Status * Current AJJF member Current AJTA member None of the above - $5 event fee NOTE: ATJA Members can take any class brown belt rank or below that they are qualified to take. For example a blue belt can not take brown belt level classes. Membership Number * Enter your membership number, or 0 if unknown but please find your number as it will help the process. Membership Expires * Lifetime members, please enter 01/01/2030 AJJF Rank * Junior (junior rank) Rokyu (white) Gokyu (blue) Yonkyu (green) Sankyu (brown 3) Nikyu (brown 2) Ikkyu (brown 1) ----------------------------- Shodan Nidan Sandan Yodan Godan Rokudan Shichidan Hachidan Kudan Judan ------------------ Other Rank No AJJF Rank Background Screen Status * My background screen is current through convention weekend My background screen needs to be renewed, I will do so prior to convention weekend Please contact me about background screening I am not an AJJF black belt AJJF Black Belts: Please ensure that your background screen is current through convention weekend. If you need to renew you may do so here. If you are unsure, select the 'contact me' option. If you are not black belt rank, background screening is not required. Registration Options for Convention - Adult Banquet is Island Dinner Buffet, Salmon, Chicken & Ribs Adult/Teen Package Choice (age 14 or older) * Adult Clinics, Banquet, T-Shirt $210 Adult Clinics-only, 2 days $140 Adult Clinics-only, 1 day only $100 Price before 4-15-2023 Adult/Teen Package Choice (age 14 or older) * Adult Clinics, Banquet, T-Shirt $220 Adult Clinics-only, 2 days $150 Adult Clinics-only, 1 day only $110 Price after 4-14-2023 Junior Package Choice (age 13 or younger) * Junior Clinics, Junior Banquet, T-Shirt $110 Junior Clinic 2 days $70 Junior Clinic 1 day only $40 Price before 4-15-2023 Junior Package Choice (age 13 or younger) * Junior Clinics, Junior Banquet, T-Shirt $120 Junior Clinic 2 days $80 Junior Clinic 1 day only $50 Price after 04-14-2023 T-Shirt Size * Men's Small Women's Small Youth Small Men's Medium Women's Medium Youth Medium Men's Large Women's Large Youth Large Men's X-Large Women's X-Large Men's XX-Large Women's XX-Large No Shirt Please For the banquet please seat me with the following dojo Extra Items Banquet Adult: Enter the number of additional adult banquet tickets under meal choice @ $85.00 ea. Must be purchased by 4/14/2023 Adult guest banquet tickets Enter the number of additional junior banquet tickets below @ $45.00 ea. Must be purchased by 4/12/2023 Junior guest banquet tickets Extra T-shirts @ $25 each available in adult and youth sizes. Must be purchased by 4/12/2023 Men's Small Women's Small Youth Small Men's Medium Women's Medium Youth Medium Men's Large Women's Large Youth Large Men's XL Women's XL Men's XXL Women's XXL Bonus Activities Download The Freestyle Contest Flyer Saturday Juniors Freestyle Contest $25 * Yes. My child would like to participate in the freestyle contest $25 No, thank you. My child does not wish to enter the freestyle contest I am unsure. I will check with my child's sensei about the freestyle contest Contest participation is optional. The National Freestyle Contest will be held on Saturday from 10:30am-12:30pm. The entry fee is $25. If you are uncertain if your child will participate, you can obtain a registration form and pay at the front desk for the National Freestyle Contest. It is super fun! Check with the chair of clinics and contests if you have additional questions. Or link here to read more about the National Freestyle Contest. Saturday National Freestyle Contest $25 * Yes. I want to enter the freestyle contest $25 No, thank you. I do not wish to enter the freestyle contest Contest participation is optional. The National Freestyle Contest will be held on Saturday from 10:30am-12:30pm. The entry fee is $25. If you are uncertain if you will participate, you can obtain a registration form and pay at the front desk for the National Freestyle Contest. It is super fun! Check with the chair of clinics and contests if you have additional questions. Or link here to read more about the National Freestyle Contest. National Freestyle Contest Division * Junior Intermediate (age 12 and under, one to two years jujitsu experience) Junior Advanced (age 12 and under, more than two years jujitsu experience) Senior 5th or 4th Kyu (age 13 and up, yellow, blue or green belt) Senior 3rd or 2nd Kyu (age 13 and up, brown - sankyu or nikyu) Senior 1st Kyu (age 13 and up, brown - ikkyu) Shodan (1st degree black belt) Nidan (2nd degree black and up) Freestyle Contest Judging - Please Help * Yes! I will help with the freestyle contest Maybe! I'm pretty sure I can help, please contact me No, thank you. I cannot help with the freestyle contest The National Freestyle Contest will be Saturday 10:30am-12:30pm. We need volunteers to judge and referee the freestyle contest! No worries if you haven't judged before. Please help. Saturday Schoolheads Breakfast Meal Ticket @ $30.00 ea. Schoolheads or Sempai only AJJF is a non-profit, tax exempt organization. If you wish to make a tax deductible donation, please enter the amount below PLEASE NOTE *BANQUET* - Note if we have not received your registration prior to 04/14/2023, you may not receive a banquet meal ticket. *T-SHIRTS* - Note if we have not received your registration prior to 04/12/2023, you may not receive a shirt in your size or we may even be sold out. WAIVER AND RELEASE OF LIABILITY “In consideration of this membership, I agree for myself, my heirs, successors and assigns to waive and release all liability, not file any lawsuit or any other action, and to indemnify and hold harmless the American Judo & Jujitsu Federation (AJJF), its directors, professors, officers, employees, committee members, instructors, members, affiliated dojos or schools for any injury, or other legal cause of action arising out of the study or practice of Danzan Ryu Jujitsu or any activity taught, practiced or conducted in connection with my membership in the AJJF. This waiver, release, and indemnity includes, but is not limited to injuries or any other legal cause of action occurring in classes, demonstrations, competitions or otherwise, and I waive and release any and all claims or rights that I may have in any jurisdiction for any liability arising out of any legal cause of action, including but not limited to, any liability from negligence and agree to indemnify and hold harmless the parties listed in the prior sentence. I understand that the study and practice of martial arts in general, and Jujitsu, in particular, is an inherently dangerous activity and may lead to serious and permanent physical injury and/or death. Intending to be legally bound by my signature Below, I acknowledge the above and for all time knowingly and voluntarily assume any and all risks associated with the study and practice of Danzan Ryu Jujitsu or any martial art. The AJJF BOP reserves the right to suspend any individual or school membership at any time. I have read this waiver. I agree to adhere to the rules and standards of the AJJF. I further understand that only AJJF-sanctioned classes and events are covered by the AJJF group Insurance.” I am over 18 or I am the parent or legal guardian of the above named Convention participant. I have read the release and agree accordingly. Waiver Signature * Clear Total Convention Price * If you are human, leave this field blank.