Certificate No. P ‘Grade Given APPLICATION FOR DAN-KYU pin] GRADING EXAMINATIONS —— [Renk Aprlicdfor | [Attendance ater eae Kyu pre haa} | ise Rak Otanes Aikido World Headquerters Preece = 17.38 Wakamateu-sho it : Shine Toye ‘i ‘Aikibal Mabe Date of Aiea Please print or type| 10. Registration (ew)_— reat eu) First Name Samame Date of Brith Sex MR Gatakena) : (im) amt 0 cadarens Nationality . ‘Secapalon Name of Dolo resent Rank ‘Where and When Preset Dates Rank Obtained es woot) ow Dan ‘by Examination ven | Place Method (rele one): By Recommendation Date of Upcoming Greniners Signatore Examination on (wana Remarks - Thereby make my application. Foam Date Signatur Registration Fee srRvcrions: 1. Fil nal the relevant barks within th neavy boxes zed len where indicated. 5. Soon after the exainaton, a ist of suceectfl apifeants wil be posted. if your aame appears on the isi, you must register your tion fea, “Membership No. AIKIDO HEADQUARTERS REGISTRATION FORM fro not refundable for any roar, —— | | | s 3 3 Ii: ; | tat 3 g sg YE 2, Phite how your membership cart when applying Address Occupation Dromotin a ths oie and reeive your eertilcate. Fullte to do 20 may result tthe cancellation ofthe grein. cur HERE Signature ‘Name of Dojo