edinburgh university

shukokai karate club

http://shukokai.eusu.ed.ac.uk

APPLICATION FOR RENEWING MEMBERSHIP 2005/2006

Please complete the application form using BLOCK CAPITALS, and submit to a member of the
committee. As you are a returning member and know you are going to be joining, please do this as soon as
possible.

Name Faculty
Date of Birth UG/PG
Matric. No. Year of study
E-mail Address

Term Time Address (Please Include Postcode or License Cannot be Applied For)

Mobile Telephone

Home Address (Please Include Postcode or License Cannot be Applied For)

Telephone

Please give details of any previous martial arts Please give details of any injury or illness of
experience. which the instructor should be aware.

Are you a qualified first-aider? [ YES / NO ]

Do you own or have easy access to a car? [ YES / NO ]

Please score from 1-10, how important the Please fill in the following details to allow for
following are to you, relative to each other: efficient club administration:
1. Fitness Current grade
2. Sport Date last graded
3. Self-Defense AMA license no.
4. Just enjoying Karate as a study break License expiry date

Chief Instructor: Steven Webster

4th Dan Ao Denkou Jitsu, 2nd Dan Shukokai Karate, 2nd Dan Hontai Yoshin Ryu Ju Jitsu
Members of
Ao Denkou Kai Scotland, Ao Denkou Kai International, Amateur Martial Association