SHUDOKAN MARTIAL ARTS ASSOCIATION MEMBERSHIP APPLICATION

PLEASE PRINT OR TYPE ALL INFORMATION

NAME_______________________________________________________________________

DATE OF BIRTH______________________________________________________________

STREET ADDRESS_____________________________________________________________

CITY_____________________________ STATE/PROVINCE___________________________

ZIP/POSTAL CODE__________________ COUNTRY__________________________________

TELEPHONE__________________________________________________________________

E-MAIL ADDRESS_____________________________________________________________

EDUCATION RECEIVED_________________________________________________________

RANK APPLYING FOR (IF ANY)_________________________________________________

RECOMMENDED BY_____________________________________________________________

DIVISION CHOICE: [ ] Traditional Karate    [ ] Iaido
                 [ ] Traditional Jujutsu   [ ] Goshin-jutsu
                 [ ] Judo                  [ ] Aikido

I hereby certify that the above information is true and accurate. Further,
I do hereby, for myself, my heirs, executors and administrators, waive
release and forever discharge any and all rights and claims for damages
which I may have or which may hereafter accrue to me against the Shudokan
Martial Arts Association, or their respective officers, agents,
representatives, successors and/or assigns, for any and all damages
which may be sustained and suffered by me in connection with my association
with or entry in the martial arts activities associated with the Shudokan
Martial Arts Association. In addition, by my signature, I certify I
understand that submission of a completed application and the appropriate
fee does not guarantee the awarding of requested rank and/or teaching
title, or any rank and/or teaching title.

SIGNATURE_____________________________________________ DATE________________
 (PARENT OR LEGAL GUARDIAN IF UNDER 18 YEARS OF AGE)

___________________________________     ___________________________________  
Traditional Karate                      Iaido
Division Director                       Division Director

___________________________________     ___________________________________  
Traditional Jujutsu                     Goshin-jutsu
Division Director                       Division Director

___________________________________     ___________________________________  
Judo                                    Aikido
Division Director                       Division Director