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21st National World Funakoshi Shotokan Karate Championship

Organised By : WORLD FUNAKOSHI SHOTOKAN KARATE ORGANISATION


ON 5th September 2010 At Priydarshini Sports Complex, Mumbai – 80.
GROUP APPLICATION FORM
No. Name in Capital Letters Age Sex Rank Kata Kumite
M/ F
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Important
I, the undersigned Mr. ______________________________________, submit my student's
application for attendance and participation in the above Karate Championships at Priyadarshini
Sports Complex on 5th September 2010. In case of any injury the Federation/Organiser will not be
responsible. No Claim will be acceptable by Federation/Organiser. I fully understant that any
medical treatement given to my student will be of a first-aid type only.

_____________________ ___________________ __________________________


BRANCH. Mobile No. Instructor Name & Signature.

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