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Wadoryu Karatedo Kenkyukai Licence application form Name....................................................................................... Address.................................................................................... ................................................................................................ Postcode........................... Date of birth........../........../.......... Telephone no (................) ................... email..................................................................................... Date of starting Karate........./........./......... Have you ever been a member of any other Martial arts organisation? yes/no If yes please list details including grade and the date achieved, and club/association ............................................................................................................. Have you ever been convicted of any crime of violence yes/no If yes please give details....................................................................... I declare that the information I have provided is correct, and will inform the licensing officer of any change in the above details. I swear to abide by the rules of the Wadoryu Karatedo Kenkyukai and the constitution of the Alliance of International Wadoryu. Signed....................................................................... Dated........./........./.......... (parent or guardian if under 16 years of age) Senior licence £20.00. Junior (u16) or conc. £15.00 |
