edinburgh university

shukokai karate club

http://shukokai.eusu.ed.ac.uk

APPLICATION FOR NEW MEMBERSHIP 2005/2006

Please complete the application form using BLOCK CAPITALS, and submit to a member of the
committee. You will require a passport photograph for your license, but we do not require your
photograph with this application form.

Name Faculty
Date of Birth UG/PG
Matric. No. Year of study
E-mail Address

Term Time Address (Please Include Postcode or License Cannot be Applied For)

Mobile Telephone

Home Address (Please Include Postcode or License Cannot be Applied For)

Telephone

Please give details of any previous martial arts Please give details of any injury or illness of
experience. which the instructor should be aware.

Are you a qualified first-aider? [ YES / NO ]

Do you own or have easy access to a car? [ YES / NO ]

Please score from 1-10, how important the
following are to you, relative of each other:
1. Fitness
2. Sport
3. Self-Defense
4. Just enjoying Karate as a study break
Just the one more! Please tell us why you
decided to come along to a training session:
1. Information on our website
2. Our stand at the Sports Fair, or a flyer
3. A recommendation by a friend
4. Other:

Chief Instructor: Steven Webster

4th Dan Ao Denkou Jitsu, 2nd Dan Shukokai Karate, 2nd Dan Hontai Yoshin Ryu Ju Jitsu
Members of
Ao Denkou Kai Scotland, Ao Denkou Kai International, Amateur Martial Association