 2014 Irwin Cohen Memorial Saturday & Sunday, November 8-9, 2014 USA Judo Senior E Level Event & National Referee Examination Site # ****$1000 CASH PRIZE PER WEIGHT ***** # FOR SR. ELITE DIVISION CHAMPIONS (Must have 6 or more per division & Olympic Weights only) # WE ACCEPT CREDIT CARDS!!! WWW.COHENSJUDOCLUB.COM COMPETITION DATE Sunday, November 9, 2014 COMPETITION SITE Adlai E. Stevenson High School! 1 Stevenson Dr. ! Lincolnshire, IL 60069! Sports Center - Parking Lot E Registration & Weigh in Saturday, November 8, 2014 - 11:30am - 6:30pm! Deerfield Hyatt - 1750 Lake Cook Rd. Deerfield, IL 60015 HOTEL Deerfield Hyatt (847) 945-3400! 1750 Lake Cook Rd. Deerfield, IL 60015! $89 per room Breakfast IS INCLUDED! https://resweb.passkey.com/go/ IrwinCohenMemorialInvitational Tournament Director Aaron Cohen (847) 372-7272! Email: [email protected] Sanction Number Head Referee & Meeting USA Judo Sanction Gary Berliner IJF A! Referee meeting at Deerfield Hyatt on Saturday November 8th at 7:15 pm in the meeting room. There will also be a short meeting Sunday, November 9th at 8:15 am prior to the competition at Stevenson High School. # PRE REGISTRATION ONLY An explanation of Senior E-level and Junior level procedures and rules is contained elsewhere in this package. 1 Jr. Competition Starts! Sr. Competition Starts Sunday, November 9th at 9:30 am! Sunday, November 9th at 1:30 pm Fee per athlete for: Juniors, Men’s Novice and Men’s Masters! $60 postmarked before November 1, 2014! $85 postmarked after November 1, 2014! $25 per each additional division Fee per athlete for: Senior Elite Male and Senior Elite Female! $70 postmarked before November 1, 2014! $95 postmarked after November 1, 2014 Please Make All Checks or Money Orders Payable to: 2014 Irwin Cohen Memorial and mail to:! Cohen Brothers Training Center 400 Corporate Woods Dr. Vernon Hills, IL 60060! # DO NOT MAIL FORMS IN AFTER NOVEMBER 1st - REFUNDS AT DISCRETION OF DIRECTOR! Awards 1st, 2nd & 3rd Place Trophies Special Awards Most Oustanding Jr. & Sr. will receive a plaque Eligibility USJI, USJA, USJF card holders and any member of an NGB in any country, which are members of the IJF and have proof of insurance. Competitors must present their judo card/documentation at registration. Proof of age is required. Any international athlete must have a permission letter from their federation to compete. Rules New IJF Modified Contest Rules! No choking under 13 yrs ! No arm bars in Junior divisions or Senior Novice Divisions ! (The tournament directors reserve the right to make any changes necessary to insure the safety and fairness to all competitors) Sr. Elite Divisions Only Scoring System Match Times BLUE JUDO GI REQUIRED True Double Elimination Junior Divisions - 3 minutes! Senior Elite Female Divisions- 4 minutes! Senior Elite Male Divisions - 5 minutes! Sr. Male Novice Divisions - 3 minutes! Sr. Male Masters Divisions - 3 minutes! *Must be a current USA Judo member prior to the end of competition to be eligible for USA Junior or senior points 2 Irwin Cohen Memorial Please print legibly First Name Last Name City Address Phone Number Zip State Email Date of Birth (mm/dd/yyyy) Male Female Judo Club Age Card # USJF/USJA/USJI (USA Judo) Rank/ Color Belt Exp. Date PLEASE CHECK ONE DIVISION ONLY PER ENTRY FORM! (Novice is white & yellow belt only) AGES 5 6 7-8 9-10# NOVICE 9-10# ADV. 11-12# NOVICE 11-12# ADV. 13-14# NOVICE 13-14# ADV. 15-16# NOVICE 15-16# ADV. JR. BOYS AGES 5-6 7-8 9-10 11-12 13-16 JR. GIRLS ALL Juniors, Sr. Male Novice & Sr. Male Masters fill in Approximate weight in Pounds________________ If this form is for your SECOND division, please indicate if you want to move up in WEIGHT or AGE AGE ## WEIGHT! or # # please circle one Sr. Elite Male 55 KG 60 kg 66 kg 73 kg 81 kg 90 kg 100 kg Sr. Elite Female 48 KG 52 kg 57 kg 63 kg 70 kg 78 kg +78 kg Sr. Male Novice White- Green Belt +100 kg Sr. Male Masters 3 Certificate Regarding Non-Black Belt Contestants # I, ___________________________ a Judo instructor, who has been awarded the Judo rank (print name of instructor) of Shodan or higher by, (name of organization) ___________________________, hereby certify that, # _____________________________ although not having been awarded the Judo Rank of Shodan or (print name of contestant) higher, is of sufficient aptitude and skill in Judo to compete in these Championships. # # Judo Instructor (print) ___________________________________ Date___________________ Judo Instructor (signature) _______________________________ Date___________________ WARNING! If not signed below, you will not be allowed to participate in the tournament. # # WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE In consideration of being permitted to participate in any way, including travel to and from, the 2014 Irwin Cohen Memorial and related events and activities of United States Judo, Inc. (USA Judo), USJA, USJF, Adlai E. Stevenson High School, or Cohen Brothers Judo Training center. 1. I hereby acknowledge that I am familiar with the sport of Judo and understand the rules governing the sport of Judo. 2. Agree that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions and the elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach, supervisor, and/or a tournament official of such conditions and refuse to participate. 3. Acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, including permanent disability, traumatic brain injury or death, and severe social and economic losses due to not only my own actions, inactions, or negligence, but also to the actions, inactions, or negligence of others, the rules of the sport of Judo, or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time. 4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following such injury, permanent disability, or death. 5. Release, waive, discharge and covenant not to sue the United States Judo, Inc. (USA Judo), the United States Olympic Committee, United States Judo Federation, United States Judo Association, Illinois Judo, Inc., together with their affiliated clubs, their respective administrators, directors, agents, coaches and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents, guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises used to conduct the event, all of whom are hereinafter referred to as "releasee", from any and all claims, demands, losses, or damages on account of injury, including permanent disability and death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise to the fullest extent permitted by law. # I HAVE READ THE ABOVE WARNING, WAIVER AND RELEASE, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING THE RISK AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW. # # # ___________________________ Participant's Printed Name ____________________________ Participant's Signature _______________________ Date FOR PARENTS/GUARDIANS OF MINOR PARTICIPANTS (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications. # ## # ___________________________ Parent/Guardian Printed Name ____________________________ Parent/Guardian Signature _______________________ Date 4