USA Judo National Assembly
Coach Name Date
USA Judo Membership Number:
Contact Cell Phone Number
Individuals may only register to vote in one category!
Be sure to check the USA Judo website to verify we have received your registration. www.usjudo.org
Coaches must be a minimum of State Certified to qualify to vote
Voting instructions will be emailed to registered voters prior to the election.
THIS FORM MUST BE EMAILED TO SHERRIE WILSON NO LATER THAN OCTOBER 1, 2012
Via email: Sherrie.email@example.com
Via Postal: USA Judo/Sherrie Wilson, One Olympic Plaza, Colorado Springs, CO 80909
Via Fax: 719.866.4733