INTERNATIONAL KARATE KOBUDO FEDERATION
102 Cleveland Avenue, Reading, Pennsylvania. 19605 USA
Ph: (610) 921-3601 * IKKF Web Page: http://www.ikkf.org *
Email: Òikkf@ikkf.orgÓ
2012 INDIVIDUAL MEMBERSHIP APPLICATION
DIVISION: ( ) Karate, ( ) Karate-Kobudo, ( ) Kobudo
MEMBERSHIP
TYPE / FEE: ( )
Individual / Dojo or Affiliate
Organization Member $35
/ yr
( ) Associate / Non-Dojo Member $45
/ yr
( ) Lifetime Member $290.00
Name of Applicant
__________________________________________________________ Sex ________ Age
______
Address
_________________________________________________________________________________________
City
_____________________________________________________ State
____________________ Zip ___________
Country
________________________________________________ Phone (
) __________________________
Present
Dojo ___________________________________________ Sensei ____________________________________
Dojo
Address
_____________________________________________________________________________________
Karate
Rank ___________________________________ Style
______________________________________________
Kobudo
Certification _________________________________________
Lineage _______________________________
Organizational
Affiliations
____________________________________________________________________________
Licenses________________________________________________________
Issued By _________________________
Each IKKF Individual / Dojo Member MUST be an active
member of a IKKF Registered Dojo or IKKF Affiliated
Organization in good standing.
All members receive a Membership Certificate, Membership Card and
Patch. Active IKKF Membership
status is required to receive any IKKF Rank Certifications. All Individual Memberships in the IKKF
are on a Calendar Year basis (except
Lifetime Membership).
By applying for membership, I hereby fully and
unconditionally release the IKKF, its Officers and Directors, Licensed
Instructors, and Member Dojos from any and all claims for any and all injuries,
accidents, or losses that I may receive while practicing the Karate-Kobudo arts
sponsored by this Federation.
Signature
of Applicant ________________________________________________________
Date__________________
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Date
Approved by IKKF ___________________ IKKF Membership No. __________________