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Joining Form

Joining Form – Ashihara Karate International – Kaicho Hoosain Narker Sabaki Fighting Karate

APPLICATION FORM (Please print this form) 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:
Ashihara Karate International Kaicho Hoosain Narker, P. O. Box 117, Retreat, 7965, South Africa Fax: +27 21 7011701 E-mail: info@ashiharakarate.org