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I.S.K.A.

International Sport
Karate Association Membership
Number:

Application for
Membership

410/

/IN6/

NAME OF HEAD INSTRUCTOR___________________________________________


NAME OF SCHOOL_____________________________________________________
NAME OF STYLE PRACTISED____________________________________________
ADDRESS OF CORRESPONDENCE ______________________________________
_____________________________STATE___________PCODE_________________
CONTACT NUMBERS Phone____________________ Fax______________________
Mobile______________________Email______________________________________
NAME OF CHIEF INSTRUCTOR (AUSTRALIA) _______________________________
ADDRESS_____________________________________________________________
_______________________________STATE______________PCODE____________
DO YOU CURRENTLY HAVE AN NCAS NUMBER? YES/NO NUMBER:__________
NUMBER OF TRAINING LOCATIONS

NUMBER OF STUDENTS

WE, THE UNDERSIGNED HEREBY ACKNOWLEDGE ACCEPTANCE OF THE


CONDITIONS AND RULES WHICH APPLY TO MEMBERSHIP UNDER THE ISKA
RULES AND BECOMING AN ACCREDITED MEMBER WITHIN 1 YEAR UNDER A
RECOGNISED GOVERNMENT BODY.
SIGNATURE OF APPLICANT_________________________DATE________________
PLEASE ATTACH $150 NEW MEMBERSHIP/$100 PROGRESSIVE MEMBERSHIP
Payment can be made by cheque or credit cardVisa, Mastercard, Bankcard or Amex only.
Make cheques payable to ISKA NSW PTY LTD or complete the credit card option below:
Card Number:

____ /____ /____ /____

Expiry Date:

_ _ /_ _

Amex Security
Code _ _ _ _

Cardholders Name:__________________________________ Signature:___________________________


SEND COMPLETED APPLICATION FORM & PAYMENT TO:
I.S.K.A. NSW PTY LTD
20 ZADRO AVE
BOSSLEY PARK NSW 2176

ENQUIRIES TO PAUL ZADRO ON:


02 9823 1200 OR
0408 225 391

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