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JUTSU KAN KARATE DOFEDERATION
MEMBER OF: WORLD BUDO FEDERATION
Room No 105,1st Floor, S.R.A Building No.7, Arey Milk Colony,Mayur Nagar, Unit No.29 Goregaon(E),Mumbai - 400065. Maharashtra - India.
APPLICATION FORM FOR INTERNATIONAL AFFILIATION(ASIA)
(To be filled in BLOCK LETTERS only.)
COUNTRY NAME:………………………………………………………………………………………………………………………… …………Affix Passport
INSTRUCTOR NAME: .......................................................................................................... ...................
Size Photo
PRESENT DAN RANK.........................................................................................................................
DATE OF BIRTH...................................................... SEX:
Male
Here
Female
ADDRESS...................................................................................................................... .....................................................
..........................................................................................................................................................................................
............................................................................................................................. ....ZIPCODE.....................................................
CONTECT NO: ....................................... FAX NO. ................................. Mob. .......................................
EMAIL ID............................................................................................................................. ................................................
WEBSITE: ………………………………………………………………………………………………………………………………………………………………………………
NAME OF CLUB/ORGANIZATION: ..............................................................................................................................................
I abide by all the rules and regulations of the Association.
DATE:
SIGNATURE:
____________
PLACE:
NOTE:
1. Affix Passport Size Photo.
2. Please Attach Photo Copy of Id & Address Proof, Such as Voter Id Card, Passport & PAN Card with this Form.
3. Please attach your Bio-Data & Karate History & Photocopy of Present Dan Rank Certificate.
OFFICE USE ONLY
Affiliation No:
Date: ________________________
Signature of authority:
____________________________