Convention Registration Form Convention Registration 2022 - Virtual First Name * Last Name * Dojo Name * Please enter the name of the dojo where you attend classes. Or enter Unaffiliated if independent. Email * Please double-check your entry. We will send the zoom link(s) for the event to the email address you have entered. Phone Number 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 AJJF Membership Current AJJF membership required for all participants. Membership cards of AJJF recognized organizations also accepted - USA Judo and ATJA. If you are a regular member of 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 Membership Number * Enter your membership number, or 0 if unknown. Membership Expires * Lifetime members, please enter 01/01/2025 AJJF Rank * Shodan Nidan Sandan Yodan Godan Rokudan Shichidan Hachidan Kudan Judan ------------------ Other 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 are unsure, select the 'contact me' option. If you are not black belt rank, background screening is not required. Registration Options This year's virtual convention is being held for your benefit and is being offered to you at no cost.It is being produced, directed, and staffed by volunteers. Your fellow yudansha have donated their time and resources to bring this event together. That being said, it is not without cost to the AJJF to produce this event. Therefore we are asking for a donation to offset the cost of production and to honor the AJJF for its selfless service. Please give generously, If you are not in a place to do so then please attend the convention as our guest. We are after all Ohana and it is our desire to have all of our family present at our table. All reservations and donations are strictly confidential. All donations are in lieu of registration fees.A suggested minimum donation of $25 is requested but not required. Tax Deductible Registration Donation AJJF is a non-profit, tax-exempt organization. If you wish to make a tax-deductible donation, please enter the amount here. 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.