WSKF RENSEIKAN Membership Application Form
Please use BLOCK CAPITALS and fill in all details.
Date of Birth:
(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)
Have you ever been convicted of a crime of violence?
If yes, please give brief details.
Do you suffer a medical condition that could affect or prevent you practicing Karate?
If yes, please give details including any regular medication.
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.
Parent or guardian signature if under 18 years
I accept that training in karate could involve the risk of injury
I agree the use of your training picture on
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
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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