Page 1

WORLD KOBUDO FEDERATION MEMBERSHIP APPLICATION FORM PLEASE PRINT/S.V.P. IMPRIMER

Full Name: Nom Complet:____________________________________________________________ Date of Birth: Date de Naissance:_________________________________________________________ Address/Adresse:__________________________________________________________ __________________________________________________________ Tel: Home/Domicile:_____________________ Office/Bureau:_____________________ Medical Condition/Condition Medicale:________________________________________ Occupation/Profession:_____________________________________________________ Present Rank/Grade Actuel:__________________________________________________ Dojo Name & Address: Nom et Adresse du Dojo:____________________________________________ _____________________________________________ Instructor’s Name: Nom de l’Instructeur:______________________________________________

I hereby certify the above information to be true. Je declare que les renseignements fournis ci-dessus sont juste. Signature:_______________________________ Date:___________________________ FOR OFFICE USE ONLY/POUR USAGE DU BUREAU SEULEMENT Country of Origin/Pays d’origine:____________________________________________ Passport #:_____________ Date Issued:______________ Expiry Date:_____________ Renewal/Reabonnement:___________________________

wkf  

membership form

Read more
Read more
Similar to
Popular now
Just for you