Dan Rank Application

This form is to be completed by a USJJO Certified Rank Examiner.  After submission with the proper fees, a certificate will be produced and mailed to the address entered on this form.




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Registrant Fee: $0.00



Billing information


Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*UNITEDSTATESJUJITSUO 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
Please enter your full name in the space below.
 


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Registration inquiries:
For additional information, call Sarah Stanton at (440)476-9164 or email at sarah.stanton@usjjo.org
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Waiver of Liability
In consideration of being allowed to participate in any way in any USJJO organization
program, related events and activities, the undersigned:
Agree that the parent(s) of legal guardian(s) will instruct the minor participant that prior
to participating, he or she should inspect the facilities and equipment to be used, and if
the participant believes anything is unsafe, he or she will immediately advise his or her
coach or supervisor of such condition(s) and refuse to participate.
Acknowledge and fully understand that each participate will be engaging in activities that
involve risk of serious injury, including permanent disability and death, and sever social
and economic losses which might result not only from their own actions, inactions or
negligence, but the actions, inactions or negligence of others, the rules of play, or the
condition of the premises or of any equipment used. Further, that there may be other risks
not known to us or not reasonably foreseeable at this time.
Assume all the forgoing risks and accept personal responsibility for the damages
following such injury, permanent disability or death.
Release, waive, discharge and covenant not sue the USJJO, its officers, its affiliated
clubs, their respective administrators, directors, officers, agents, coaches, referees, and
other employees of the organization, the participants, sponsoring agencies, sponsors,
advertisers, and , if applicable, owners and lessees of the premises used to conduct the
event, all of which are hereinafter referred to as the ‘releasees’ from any and all liability
to each of the undersigned, his or her heirs and next of kin for any and all claims,
demands, losses or damages on account of injury including death or damage to property,
caused or alleged to be caused in whole or in part by the negligence of the releasee or
otherwise.
I have read the above waiver and release, understand that they have given
up substantial rights by accepting it voluntarily
Check this box to indicate that you have read and agree to all of the above terms & conditions