PERSATUAN KARATE-DO HOSHI RYU

KUALA LUMPUR
(PPS NO: N – KUL – 10765)

KARATE GRADING FORM

Details are follows:

DATE: 30th September 2023 (Saturday) TIME: 10.00am – 1.00pm
VENUE: DEWAN BERINGIN TAMAN SERI GOMBAK
ENTRY FORM
JANAARDHANAN KANTHA KUMAR
NAME:……………………………………………………. 9
AGE:……………
140905-01-1375
IC NUM:………………………………………………….. 05/09/2014
DATE OF BIRTH:…………………..
010-2209106
TEL:....................................... MALE
SEX:………………….
TAMAN MELAWATI
CENTER/DOJO:………………………………………………… Belt Size : …………………………..
(x) SELECT YOUR GRADE TO GO

GRADE FEES ( RM ) *
WHITE TO YELLOW ( 10th kyu) RM100.00
YELLOW TO ORANGE ( 9th kyu ) RM110.00
ORANGE TO GREEN ( 7th kyu ) RM120.00
GREEN TO BLUE ( 6th kyu ) RM130.00
BLUE TO PURPLE ( 5th kyu ) RM140.00
PURPLE TO BROWN 4 ( 4th kyu ) RM150.00
BROWN 4 TO BROWN 3 ( 3rd kyu ) RM160.00
BROWN 3 TO BROWN 2 ( 4th kyu ) RM170.00
BROWN 2 TO BROWN 1 ( 2nd kyu ) RM180.00
BROWN 1 TO BLACK ( 1st kyu ) RM380.00

INSTUCTOR SIGNATURE: PARENTS SIGNATURE

…………………………………… ……………………………………

ALL THE FORMS MUST BE SUBMITTED WITH FEES BEFORE ONE WEEK THE GRADIND DATE

SECRETARY ADD: 1-4-9 JALAN 1/50 DIAMOND SQUARE OFF JALAN GOMBAK 53300 KUALA LUMPUR
TEL: 016 – 200 2084 SUGU E-mail: karatehoshiryu@gmail.com