# 2014 Irwin Cohen Memorial FOR SR. ELITE DIVISION CHAMPIONS


2014 Irwin Cohen Memorial
Saturday & Sunday, November 8-9, 2014
USA Judo Senior E Level Event & National Referee Examination Site
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****$1000 CASH PRIZE PER WEIGHT *****
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FOR SR. ELITE DIVISION CHAMPIONS
(Must have 6 or more per division & Olympic Weights only)
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WE ACCEPT CREDIT CARDS!!! WWW.COHENSJUDOCLUB.COM
COMPETITION DATE
Sunday, November 9, 2014
COMPETITION SITE
Adlai E. Stevenson High School!
1 Stevenson Dr. !
Lincolnshire, IL 60069!
Sports Center - Parking Lot E
Registration & Weigh in
Saturday, November 8, 2014 - 11:30am - 6:30pm!
Deerfield Hyatt - 1750 Lake Cook Rd. Deerfield, IL 60015
HOTEL
Deerfield Hyatt (847) 945-3400!
1750 Lake Cook Rd. Deerfield, IL 60015!
$89 per room Breakfast IS INCLUDED!
https://resweb.passkey.com/go/
IrwinCohenMemorialInvitational
Tournament Director
Aaron Cohen (847) 372-7272!
Email: [email protected]
Sanction Number
Head Referee &
Meeting
USA Judo Sanction
Gary Berliner IJF A!
Referee meeting at Deerfield Hyatt on Saturday November
8th at 7:15 pm in the meeting room. There will also be a
short meeting Sunday, November 9th at 8:15 am prior to
the competition at Stevenson High School.
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PRE REGISTRATION ONLY
An explanation of Senior E-level and Junior level procedures and rules is contained elsewhere in this package.
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Jr. Competition Starts!
Sr. Competition Starts
Sunday, November 9th at 9:30 am!
Sunday, November 9th at 1:30 pm
Fee per athlete for: Juniors, Men’s Novice and
Men’s Masters!
$60 postmarked before November 1, 2014!
$85 postmarked after November 1, 2014!
$25 per each additional division
Fee per athlete for: Senior Elite Male and
Senior Elite Female!
$70 postmarked before November 1, 2014!
$95 postmarked after November 1, 2014
Please Make All Checks or Money Orders Payable to: 2014 Irwin Cohen Memorial and mail to:!
Cohen Brothers Training Center 400 Corporate Woods Dr. Vernon Hills, IL 60060!
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DO NOT MAIL FORMS IN AFTER NOVEMBER 1st - REFUNDS AT DISCRETION OF DIRECTOR!
Awards
1st, 2nd & 3rd Place Trophies
Special Awards
Most Oustanding Jr. & Sr. will receive a plaque
Eligibility
USJI, USJA, USJF card holders and any
member of an NGB in any country, which are
members of the IJF and have proof of
insurance. Competitors must present their
judo card/documentation at registration. Proof
of age is required. Any international athlete
must have a permission letter from their
federation to compete.
Rules
New IJF Modified Contest Rules!
No choking under 13 yrs !
No arm bars in Junior divisions or Senior
Novice Divisions !
(The tournament directors reserve the right to
make any changes necessary to insure the
safety and fairness to all competitors)
Sr. Elite Divisions Only
Scoring System
Match Times
BLUE JUDO GI REQUIRED
True Double Elimination
Junior Divisions - 3 minutes!
Senior Elite Female Divisions- 4 minutes!
Senior Elite Male Divisions - 5 minutes!
Sr. Male Novice Divisions - 3 minutes!
Sr. Male Masters Divisions - 3 minutes!
*Must be a current USA Judo member prior to the end of competition
to be eligible for USA Junior or senior points
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Irwin Cohen Memorial
Please print legibly
First Name
Last Name
City
Address
Phone Number
Zip
State
Email
Date of Birth (mm/dd/yyyy)
Male
Female
Judo Club
Age
Card # USJF/USJA/USJI (USA Judo)
Rank/ Color Belt
Exp. Date
PLEASE CHECK ONE DIVISION ONLY PER ENTRY FORM!
(Novice is white & yellow belt only)
AGES
5
6
7-8
9-10#
NOVICE
9-10#
ADV.
11-12#
NOVICE
11-12#
ADV.
13-14#
NOVICE
13-14#
ADV.
15-16#
NOVICE
15-16#
ADV.
JR. BOYS
AGES
5-6
7-8
9-10
11-12
13-16
JR. GIRLS
ALL Juniors, Sr. Male Novice & Sr. Male Masters fill in Approximate weight in Pounds________________
If this form is for your SECOND division, please indicate if you want to move up in WEIGHT or AGE
AGE ##
WEIGHT!
or #
#
please circle one
Sr. Elite Male
55 KG
60 kg
66 kg
73 kg
81 kg
90 kg
100 kg
Sr. Elite Female
48 KG
52 kg
57 kg
63 kg
70 kg
78 kg
+78 kg
Sr. Male Novice White- Green Belt
+100 kg
Sr. Male Masters
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Certificate Regarding Non-Black Belt Contestants
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I, ___________________________ a Judo instructor, who has been awarded the Judo rank
(print name of instructor)
of Shodan or higher by, (name of organization) ___________________________, hereby certify that,
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_____________________________ although not having been awarded the Judo Rank of Shodan or
(print name of contestant)
higher, is of sufficient aptitude and skill in Judo to compete in these Championships.
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Judo Instructor (print) ___________________________________ Date___________________
Judo Instructor (signature) _______________________________ Date___________________
WARNING! If not signed below, you will not be allowed to participate in the tournament.
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WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE
In consideration of being permitted to participate in any way, including travel to and from, the 2014 Irwin Cohen Memorial and related
events and activities of United States Judo, Inc. (USA Judo), USJA, USJF, Adlai E. Stevenson High School, or Cohen Brothers Judo
Training center.
1. I hereby acknowledge that I am familiar with the sport of Judo and understand the rules governing the sport of Judo.
2. Agree that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions and the elimination or
scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach, supervisor,
and/or a tournament official of such conditions and refuse to participate.
3. Acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, including permanent
disability, traumatic brain injury or death, and severe social and economic losses due to not only my own actions, inactions, or negligence,
but also to the actions, inactions, or negligence of others, the rules of the sport of Judo, or conditions of the premises or of any equipment
used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time.
4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages following
such injury, permanent disability, or death.
5. Release, waive, discharge and covenant not to sue the United States Judo, Inc. (USA Judo), the United States Olympic Committee,
United States Judo Federation, United States Judo Association, Illinois Judo, Inc., together with their affiliated clubs, their respective
administrators, directors, agents, coaches and other employees or volunteers of the organization, event officials, medical personnel, other
participants, their parents, guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners,
lessors, and lessees of premises used to conduct the event, all of whom are hereinafter referred to as "releasee", from any and all claims,
demands, losses, or damages on account of injury, including permanent disability and death and damage to property, caused or alleged to
be caused in whole or in part by the negligence of the releasee or otherwise to the fullest extent permitted by law.
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I HAVE READ THE ABOVE WARNING, WAIVER AND RELEASE, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING THE RISK AND CONDITIONS
INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM
UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/GUARDIAN AS EVIDENCED BY THEIR
SIGNATURE BELOW.
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___________________________
Participant's Printed Name
____________________________
Participant's Signature
_______________________
Date
FOR PARENTS/GUARDIANS OF MINOR PARTICIPANTS (UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided
above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the
Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, even
if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and
conditions and their ramifications.
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___________________________
Parent/Guardian Printed Name
____________________________
Parent/Guardian Signature
_______________________
Date
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