Junior National Judo Championships – 2022–23 W

16th to 20th December 2022 at Ranchi, Jharkhand

Entry Form - JUNIOR WOMEN
O
Age Group: Above 15 Yrs. to below 21 Yrs. M
E
N
NAME OF THE STATE / UT: ………………………………………………………………………………………………………………
Weight Cty. Full name Date of Birth Father’s Name Mobile No. Email ID Full Address
- 44 Kg
- 48 Kg
- 52 Kg
- 57 Kg
- 63 Kg
- 70 Kg
- 78 Kg
+ 78 Kg
Coach
Manager
I have verified the birth certificates/documents of the above athletes and found correct as mentioned in this entry form. Certified that none of the above athletes/officials are facing any
violation of Doping Rules, Age Fraud, Sexual and Metal harassment cases, or any enquiry is pending. I also verified that all the above members are fully vaccinated and those who are not
vaccinated carrying the RT PCR Test report in Negative. The undersigned / association is responsible for any misconduct on the same as well as during the event.

President/Secretary
State Judo Association ( Signature & Stamp )
Important Note :
1. The Entry Form MUST be neatly typed.
2. Entry Form MUST be submitted in DUPLICATE
3. The Full address, Mobile number and Email ID of the individuals are mandatory for official purpose.
 M
E
Junior National Judo Championships – 2022–23 N
16th to 20th December 2022 at Ranchi, Jharkhand
Entry Form - JUNIOR MEN
Age Group: Above 15 Yrs. to below 21 Yrs.

NAME OF THE STATE / UT: ………………………………………………………………………………………………………………

Weight Cty. Full name Date of Birth Father’s Name Mobile No. Email ID Full Address
- 55 Kg
- 60 Kg
- 66 Kg
- 73 Kg
- 81 Kg
- 90 Kg
- 100 Kg
+ 100 Kg
Coach
Manager
I have verified the birth certificates/documents of the above athletes and found correct as mentioned in this entry form. Certified that none of the above athletes/officials are facing any
violation of Doping Rules, Age Fraud, Sexual and Metal harassment cases, or any enquiry is pending. I also verified that all the above members are fully vaccinated and those who are not
vaccinated carrying the RT PCR Test report in Negative. The undersigned / association is responsible for any misconduct on the same as well as during the event.

President/Secretary
State Judo Association ( Signature & Stamp )
Important Note :
1. The Entry Form MUST be neatly typed.
2. Entry Form MUST be submitted in DUPLICATE
3. The Full address, Mobile number and Email ID of the individuals are mandatory for official purpose.