MEMBERSHIP APPLICATION FOR THE ASSOCIATION & DOJO

I.I.A.O.K.A.- Kobudo  

E.M.S.O.I.

Isshando International American Okinawan Karatedo Association

Ed McGrath’s School of Isshinryu Karatedo & Kobudo

IIAOKA & Kobudo Association

1025 Martin Bench Court Wake Forest, NC 27587

$40.00 Basic Membership Organization &  Dojo

First Name:____________________________________ MI:_______ Last Name:_______________________________ Age:______ DOB:____/____/____

Address:_______________________________________________________ City:____________________________ State:___________________________

Zip:________________________

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

Email:________________________________

Current Grade Kyu Rank:____________________   Current Dan Rank:/ Title if any:  ____________________________________

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 & Kobudo may be terminated by just cause for any infringement of the established and published rules and regulations of the EMSOI & IIAOA & Kobudo.

Signature & Date Required : ________________________________________________________   ______/______/_________