ADULT REGISTRATION Choose your situation * : Registration renewalNew registration Name * : First name * : Sexe * : MaleFeminine Birth date * : Email * : Phone * : Address * : Code postal * : City * : Thanks to this form, I wish to take a license Judo Judo Club Lansargues with the French Judo Federation and participate in trainings sessions and meetings organized in the Judo Club Lansargues. I also agree with the insurance Bodily Accidents proposed by the FFDJA not mandatory, I acknowledge having been informed of the risks to the practice of Judo and D. A. that could endanger my physical integrity. I authorize sports instructors of Judo Club Lansargues, as part of activities, to take all emergency measures about me, in case of emergency, accident or serious illness, so I receive the necessary care. I note that the facilitator ensures only responsibility during activities. Insofar images of myself would be taken during sports, I authorize Judo Club Lansargues to use them freely free of charge (without payment) for carrying out various information and communication media. * By checking this box I certify be in possession of a valid medical certificate of non-cons-indication to the sport of judo, including competition. Choice of payment method * : —Veuillez choisir une option—CheckBank card Choose the category of registration * : —Veuillez choisir une option—Judo adult, Self-défensecorrects Choose the category of registration * : —Veuillez choisir une option—Judo adult, Self-défensecorrects Amount to be paid : 210 €, by cheque Entrusting the payment of the contribution to the teaching staff as well as the registration form. Thank you. Amount to be paid : 170 €, by cheque Entrusting the payment of the contribution to the teaching staff as well as the registration form Amount to be paid : 210 €, by cheque Entrusting the payment of the contribution to the teaching staff as well as the registration form. Thank you. Amount to be paid : 170 €, by cheque Entrusting the payment of the contribution to the teaching staff as well as the registration form Amount to be paid : 210 €, by credit card Amount to be paid : 170 €, by credit card Amount to be paid : 210 €, by credit card Amount to be paid : 170 €, by credit card Download the d & rsquo; registration in case of problem & rsquo; access : Registration Copy d & rsquo; a medical certificate : Medical certificate TweetPinShare0 Shares
