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Member of

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african GOJU

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Joining Form

APPLICATION FORM: MEMBERSHIP

Name/Family Name:_____________________________________________________

Address: ___________________________________________________________

__________________________________________________________________

Telephone: _______________________ Fax: ______________________

E-mail Address:______________________________________________

Date of birth: ____________________ Current Rank: _______________

Karate/Budo Style: ___________________________________________

Grade issued by: _________________ Certificate No: _______________

(Please include photocopy with this application) (Also attach 2 ID size pictures)

ORGANISATIONAL INFORMATION:

Name of dojo/ club: ___________________________________________________________

Address of dojo/ club: ___________________________________________________________

___________________________________________________________

Dojo Telephone No: ________________ Fax No: ___________________

E-mail Address: _____________________________________________

No. of Yudansha: ____ No. of Kyu Students: ___ Total No. of Students: __

(If you have more than one dojo/club affiliated with you, complete the details above and attach a list of the names of the present instructors and the areas of all your affiliated dojo/clubs.

Please return to:
Goju Ryu Karate Kuyu-Kai: Shihan Humphrey Skosana,
P. O. Box 4311, Witbank, 1035, South Africa
Fax2 e-mail: +27 86 693 9390
E-mail:
info@kuyukaikarate.co.za

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Shihan Humphrey Skosana's Kuyu kai Karate South Africa teaches the traditional Goju-ryu karate of Osamu Hirano (Saiko Shihan) of Japan.