Kyudokan Goju Ryu Karate Do

Membership Form - New Members

Our exceptional value all in membership enables training at all our dojos and includes insurance as well as ALL future grading fees.

Please complete the form below and click submit, will then process your application and confirm your membership via email. We look forward to welcoming you to the Kyudokan.

Completion of this membership form is required for all new applicants.

"*" indicates required fields

Membership Type

I am applying for a*

Single Membership at £50 per month

Combined Membership 2 Family Members at £90 per month

Combined Membership 3 Family Members at £120 per month

Combined Membership 4 Family Members at £140 per month

Combined Membership 5 Family Members at £150 per month

Please indicate the Dojos you will be attending*

Eastleigh - Places Leisure Centre

Chamberlayne Leisure Centre

Bitterne Leisure Centre

Winchester Sport & Leisure Park

Holly Hill Leisure Centre

Member's Information

Name*

First Last

Pronoun*

Date of Birth*

Name (2nd Student)*

First Last

Pronoun (2nd Student)*

Date of Birth (2nd Student)*

Name (3rd Student)*

First Last

Pronoun (3rd Student)*

Date of Birth (3rd Student)*

Name (4th Student)*

First Last

Pronoun (4th Student)*

Date of Birth (4th Student)*

Name (5th Student)

First Last

Pronoun (5th Student)*

Date of Birth (5th Student)

Contact Information

Email Address*

Enter Email Confirm Email

Contact Number*

Alternative Email Address

Optional

Enter Email Confirm Email

Alternative Contact Number

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Parent / Guardian (if under 16)

Prefix First Last

Contact Number

Optional 2nd Parent / Guardian (if under 16)

Prefix First Last

Contact Number

Medical and Emergency Contact

Medical Conditions*

Do you have any medical conditions or allergies we should be aware of:

No

Yes

About Your Medical Condition(s)*

Emergency Contact Name

First Last

Emergency Contact Number

Declaration*

I am aware and accept that the practice of martial arts involves the risk of injury and that I agree to abide by the association rules.

Photograph / Video Consent*

Please can you confirm your approval below for club photos to be taken during events, which may be used on our website, social media, or for promotional literature:

Yes I am happy for this

No please do not include me in this

Payment

Monthly Membership*

I hereby authorise Kyudokan to set up a continuous monthly payment for £50 a month pertaining to this membership.

Monthly Membership*

I hereby authorise Kyudokan to set up a continuous monthly payment for £90 a month pertaining to this membership.

Monthly Membership*

I hereby authorise Kyudokan to set up a continuous monthly payment for £120 a month pertaining to this membership.

Monthly Membership*

I hereby authorise Kyudokan to set up a continuous monthly payment for £140 a month pertaining to this membership.

Monthly Membership*

I hereby authorise Kyudokan to set up a continuous monthly payment for £150 a month pertaining to this membership.

Cancellation*

I understand that cancelling the membership is subject to a 1 month notice period.

Payment*

Securely pay for your subscription via credit or debit card.

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Card Details

Cardholder Name

Kyudokan Goju Ryu Karate Do

Membership Form - New Members

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