|
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
|
