Eastern Collegiate Judo Association
Institutional Membership Application
Name of Institution: ___________________________ Address:____________________________________
City______________________ State______ Zip____________
Athletic Affiliation of Institution, Please Check:
______ National Collegiate Athletic Association (NCAA)
______ National Association of Intercollegiate Athletics (NAIA)
______ National Junior College Athletic Association (NJCAA)
______ Other, Please specify: _________________________
Institutional Representative
Name of Coach:__________________________ Address: _____________________________________
Phone:______________________ Email:__________________ School/Club Web Site: _______________
I, _________________, an authorized representative of ______________________, do hereby petition the members of the Eastern Collegiate Judo Association (ECJA) for the acceptance into the organization. I further pledge to recognize the ECJA as the regional representative of Eastern Collegiate Judo to the National Collegiate Judo Association and support the Constitution and By-laws of the association.
Signature of Representative
Date Membership Accepted Signature of ECJA Treasurer
ECJA Annual Dues Enclosed: $35.00 Date:_____________ (Dues due date NOV 1st 2009)
Please send check or money order payable to Eastern Collegiate Judo Association to:
Hector R. Morales
237A Barnard LpP>
West Point, NY 10996