Notts, Leic, and Mid. Regional Championship

Individual Registration

Non-BJC member

First name
Surname

Affiliation GB/BJA GB/AJA
Licence number
Club
Grade 6th Kyu: No Tabs Beginner 6th Kyu: 1 Red 6th Kyu: 2 Red 6th Kyu: 3 Red / 1st Mon 6th Kyu: 1 Orange 6th Kyu: 2 Orange 6th Kyu: 3 Orange / 2nd Mon 6th Kyu: 1 Green 6th Kyu: 2 Green 6th Kyu: 3 Green / 3rd Mon 6th Kyu: 1 Blue 6th Kyu: 2 Blue 6th Kyu: 3 Blue / 4th Mon 6th Kyu: 1 Brown 6th Kyu: 2 Brown / 5th Mon 6th Kyu: 3 Brown / 6th Mon6th Kyu: No Tabs Beginner 6th Kyu: 1 Yellow / 1st Mon 6th Kyu: 2 Yellow / 2nd Mon 6th Kyu: 3 Yellow / 3rd Mon 5th Kyu: No Tabs / 4th Mon 5th Kyu: 1 Orange / 5th Mon 5th Kyu: 2 Orange 5th Kyu: 3 Orange / 6th Mon 4th Kyu: No Tabs / 7th Mon 4th Kyu: 1 Green / 8th Mon 4th Kyu: 2 Green 4th Kyu: 3 Green / 9th Mon 3rd Kyu: No Tabs / 10th Mon 3rd Kyu: 1 Blue / 11th Mon 3rd Kyu: 2 Blue / 12th Mon 3rd Kyu: 3 Blue 3rd Kyu: 1 Brown / 13th Mon 3rd Kyu: 2 Brown / 14th Mon 3rd Kyu: 3 Brown / 15th Mon 3rd Kyu: 1 Black / 16th Mon 3rd Kyu: 2 Black / 17th Mon 3rd Kyu: 3 Black / 18th Mon6th Kyu: No Tabs Beginner 6th Kyu: 1 Red 6th Kyu: 2 Red 6th Kyu: 3 Red 5th Kyu: No Tabs 5th Kyu: 1 Red 5th Kyu: 2 Red 5th Kyu: 3 Red 4th Kyu: No Tabs 4th Kyu: 1 Red 4th Kyu: 2 Red 4th Kyu: 3 Red 3rd Kyu 2nd Kyu 1st Kyu 1st Dan 2nd Dan 3rd Dan 4th Dan 5th Dan

Date of birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925
Gender Male Female
Weight kg

Email address
Telephone

Address 1
Address 2
Town/City
Postcode