Dan promotion examination application form

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昇段審査申込書

1、氏名　Full name *

2、国　your country *

3、年齢　age *

4、性別　gender *

男性 Man

女性 Woman

身長　height (cm) *

体重　body weight (kg) *

5、道場名　dojo name *

6、空手歴　number of years doing karate *

7、現在の段位　current dan grade *

8、取得年月日　Acquisition date

YYYY

9、受審する段位　exam Dan grade
*

※Notes : You can only take up to one rank high.

10、帯の号数　Obi size

※You don't have to write if you don't know the size.

①現在締めている黒帯の名前がわかる写真を添付、送信して下さい。

②昇段認定状に貼る写真をメール添付して送信して下さい。

Kyokushin-shiyuukai@outlook.jp

①Please attachi a photo showing your current black belt name.

②Please attach a photo to be pasted on the Dan promotion certificate or send it as an email attachment.

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