| A request form for a refund.
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A refund is only available for those who correctly submitted the request form. If you succeeded, the cancellations will be reflected in the tournament bracket.
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| Tournament |
4th All Japan Beginners Jiu-Jitsu Championship |
| E-mail address |
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| E-mail (for confirm) |
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| Registration number |
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| Residence |
Foreign nationals living in Japan
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| Name |
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| ID number |
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| School name |
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| Sex |
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| Age division |
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| Belt |
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| Weight division |
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| Open class/Absoluto |
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| Comments |
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