THE VICTORIAN INTERNATIONAL OPEN CHAMPIONSHIPS


AN OCEANIA CONTENTAL UNION TOURNAMENT

Type of Participant Contestant Manager Coach Referee

Surname:

Given and Middle Names:
Different name used (if any): Nationality or Citizenship:

Married Single Male Female
Profession / Occupation:
Place of Birth:
Date of Birth: Day: Month: Year:
City: Province: Country:

Home Address:
Suburb: Province:
Country: Post Code:

Telephone Details:  
After Hours: (          ) Business Hours: (          )
Contact in Melbourne: (          ) Facsimile: (          )
Email:

Referee Grade or
Judo Grade:
   Weight Division:
(Kgs )		 Age on
03/10/08:		 Club:
Personal Information of Best contest achievements:



While all care will be exercised I agree that no responsibility will be accepted by any member of the Organising
Committee or Tournament in the case of any injury or disability being sustained.

Signed:_________________________________________________ Date: ________________

If a competitor is under 18 years of Age a parent of Guardian must sign as consent to their child competing.

Parental Consent Signature: _____________________________________________________________

I enclose AUD $45.00 entry fee. Cheques and Money Orders / Drafts should be made payable to: Victorian International Open Championships
Entries should be sent to:- The Coordinator, Victorian International Open Championships, 1106 Malvern Road, Armadale. Victoria, Australia 3143.
The Venue is:- Monash University, Wellington Road, Clayton, Melbourne, Victoria.
Date: Saturday and Sunday, 4th and 5th October, 2008

** Entry Fees are NON-REFUNDABLE**