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Louisiana Brazilian Jiu Jitsu Federation www.LBJJF.com – info@lbjjf.

com

Registration Form for the Official LBJJF Competitions


Name:______________________________________Address:________________________________________________

City: _______________________________ State/Province: _____________________Zip Code:_________________

Home Phone: _________________________ Date of Birth: _____________________ Team Name:_________________

E-mail: _____________________________________________________________________ Sex:___________________

BRAZILIAN JIU JITSU DIVISIONS: Mark (X) Absolute( open weight)


_______________BJJ Weight Classes: White Blue Purple Brown Black

4-6yrs 7-9 yrs 10- 12yrs 13-15yrs 16-17yrs

Adult Master Senior

NO GI DIVISIONS: Mark (X) Absolute( open weight)


_______________NO GI Weight Classes: Beginner Intermediate Advance

4-6yrs 7-9 yrs 10- 12yrs 13-15yrs 16-17yrs

Adult Master Senior

Xtreme Youth Martial Arts: Mark (X)


_______________Weight Classes: 7-9 yrs 10- 12yrs 13-15yrs 16-17 yrs

TOURNAMENT RELEASE AND WAIVER: I understand the rules of the tournament and will abide by them. I understand that I am participating in a
sport that has body contact and understand that injury can occur with my participation. I assume full responsibility for all of my actions during and
connected to the above tournament. I understand the risk of competing in this form of Martial Arts competition and hereby release the event organizers
and all of its employees and associates, tournament sponsors and the event facility, from any type of injury, loss, or death sustained while competing in this
competition. I also state that I am in good physical condition and know of no reason why I cannot participate in this event. I have current and valid health
insurance. I understand that The LBJJF LLC does not offer refunds and divisions or weight classes are subject to change. In case of an emergency, I hereby
authorize any licensed medical personnel to perform any accepted medical procedure deemed necessary and I agree to bear the expense of any such
treatment. I also agree that my attendance and/or performance at the tournament will be photographed, filmed, and/or taped and used exclusively by The
LBJJF LLC for promotional or commercial purposes and I waive any compensation thereof. I agree to not use ANY footage obtained at the event for
commercial purposes without expressed, written consent from The LBJJF LLC.. I have read the rules and release above and agree to all of its terms.
Signed: _______________________________ Print Name:___________________________________ Date: _________

PRICING:
Brazilian Jiu Jitsu /No Gi/XYMA
Pre Registration (until the Sunday before the event date) $65
Registration (Monday – Thursday) $85
write a check to Gracie Barra Northshore or PayPal Ellwanger@gmail.com
www.paypal.com

45616 university park ave, suite a – Hammond – LA – 70401


Phone: 985-605-3169 – Fax 985-520-0830