WSKF RENSEIKAN Membership Application Form
Please use BLOCK CAPITALS and fill in all details.
Email address *
Full Name: *
Your answer
Date of Birth: *
Address: *
Your answer
Post Code: *
Your answer
Tel: *
Your answer
Your answer
Your answer
Your answer
(Only for new applications) Have you ever practiced a martial art?
If yes, please give brief details including affiliation, grade obtained & examiner (continue on separate sheet if necessary)
Your answer
Have you ever been convicted of a crime of violence? *
If yes, please give brief details.
Your answer
Do you suffer a medical condition that could affect or prevent you practicing Karate? *
If yes, please give details including any regular medication.
Your answer
Please read carefully and if you agree, please tick below. *Personal possessions which are lost or stolen at the Dojo are the responsibility of the Visitors and Members alone and that the Club will not be responsible. *Any visitor's or Member's cars are not covered by our policy. *Member's and visitor's are NOT covered at tournaments. *
Return this form (Including a large Self Addressed Envelope)
To: Ms. Tomiko Mitsuoka, 40 Meadfield Road, Langley, Slough, Berkshire SL3 8HW
Please include 2 x passport size photographs (first application only) Joining Fee: £20.00 and Insurance Fee: £30.00
*From 1st May 2017, Cheques and Cash are no longer accepted. If you experience any problems, please let Tomoko know as soon as possible.

Bank Transfer Details:
Ms. Tomiko Mitsuoka
Nationwide / Sort Code : 07-01-16 / Account Number: 30322695

Joining Fee (Regardless of age): £20.00

Insurance One Year: £30.00

Karate Suits: Please email for more details

Monthly Fee:
6-15 years old 1 lesson/week: £35.00
6-15 years old 2 lessons/week: £40.00
16-70 years old 1 lesson/week: £40.00
16-70 years old 2 lessons/week: £45.00

Visitor’s Fee (Regardless of age): £10.00 per visit

Grading (Fee Every four months): £30.00

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