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INDIVIDUAL MEMBERSHIP FORM

Last Name:

First Name:

Street Address:

City:

State:

ZIP Code:

Country:

Email Address:

Phone:

Fax:

Date of Birth:

Sex:

Belt:

Instructor

Gi/ Kimono size:

Waiver and Release of Liability Agreement

I, the applicant, state that I am 18 years of age or over and agree to release waive and discharge, to the greatest extent permitted by law, the International Gracie Jiu-Jitsu Federation (IGJJF) from or for all claims, demands and causes of actions or any other liabilities which may arise by virtue of injuries or damages caused in connection with or arising out of membership with IGJJF, and the action or lack thereof of IGJJF, and agree that I know and understand the risks involved with the sport of Jiu- Jitsu and do hereby assume these risks and accept the responsibility for any damages or injuries by engaging in the contact sport of Jiu-Jitsu.

By clicking in this box, "I acknowledge that I read, understood and agree with the terms and conditions of the waiver."

*If you would like to pay by check or money order (please, US funds only). Please print out a copy of this application and send it along with your check or money order to:

International Gracie Jiu-Jitsu Federation
1951 W. Carson St.
Torrance, Ca. 90501 USA

PLEASE DO NOT SEND CASH!

! YOU MUST CLICK ON THE WAIVER BOX IN ORDER TO PRINT PAGE !