MEMBERSHIP APPLICATION FOR THE ASSOCIATION & DOJO

I.I.A.O.K.A. & Kobudo & E.M.S.O.I.

 

Ed McGrath’s School of Isshinryu Karatedo & Kobudo

IIAOKA & Kobudo Association

1025 Martin Bench Court Wake Forest, NC 27587

$40.00 Basic Membership Dojo

or

$40.00 Basic Membership Individual

 

 

First Name:_________________________ MI:_______ Last Name:_________________________ Age:______ DOB:____/____/____

 

Address:_______________________________________________________ City:__________________ State:______

 

Zip:______________

Phone 1:(_______) _______-_____________ Phone 2:(_______) _______-_____________

 

Email:________________________________

 

Current Grade:___________ Dan Current Rank: ____________________________________

 

Style/System:________________________________________________________________

Discipline: ___Ju Jutsu ___ Aikido/ Aiki Jitsu ___Karate Do ___ Korean ____ Filipino _____  BJJ_______

 

Other:_________________________________________

 

School:______________________________________________________________________

 

Instructor:_________________________________

 

Address:_______________________________________________________ City:__________________ State:______

 

Zip:______________

 

Dojo Phone:(_______) _______-_____________ Email:_____________________________

 

Web:__________________________________

 

 

~PLEASE ATTACH A COPY OF YOUR CURRENT RANK CERTIFICATE~

Instructor’s Name:_____________________________________________________ Rank:__________________ Title:________________

Phone:(_______) _______-_____________ Email:________________________________ Web:_____________________________________

 

Follow the instructions below completely:

1) Please attach a complete bio of your martial arts training and ranking history including dates,

instructor’s and instructor contact information

2) 2 Passport-size Photos (head & shoulders) NOTE: DO NOT STAPLE

3) If applying for School Charter: (a) Copy of First Aid Certification (Adult/Child); (b) Copy of CPR

Certification (Adult/Child); Names, ages and ranks of 5 students to be registered

4) Check or money order made payable to: Cash or PayPal for the proper amount.

 

 

I, ____________________________________, hereby certify that all information attached and presented herein is true and accurate. I certify that I am requesting membership/recognition from the IIAOKA & Kobu-do & EMSOI, and that my membership is contingent upon meeting the specified requirements and adhering to the rules, regulations and guidelines of the EMSOI & IIAOKA. I understand that membership in the EMSOI & IIAOKA & Kobu-do may be terminated by just cause for any infringement of the established and published rules and regulations of the EMSOI & IIAOA & Kobu-do.

 

 

Signature & Date Required : ________________________________________________________   ______/______/_________