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First Name Street State Instructor Full Name Birth Date Nick Name Email Start Date Fee Minimum Hours License Type Performance Evaluation Date Position Assistant Head Instructor Judo Instructor Technical Advisor

Last Name Unit/Suite Zip Rank Team End Date Rate Maximum Hours License No Student ID Emergency Contact SSN

Middle Initial City Home Phone Cell Phone Role Select Class Familyid Continuous Ed. Hrs Earned Head Instructor Student Image Filename Instructor Type Full Time Part Time Substitute Volunteer Intern Independent Contractor W4? I9?