|
Name/Family Name:__________________________________
Address: ___________________________________________
_______________________________________________________
Telephone: ________________ Fax: ____________________
E-mail Address :_____________________________________
Date of birth: ____________ Current Rank: ______________
Style: ___________________________________________
Grade issued by: _______________ Certificate No: __________
(Please include photocopy with this application) (Also attach 2 ID size pictures)
ORGANISATIONAL INFORMATION:
Name of dojang/ club: __________________________________________________
Address of dojang/ club: __________________________________________________
__________________________________________________
Dojang Telephone No: ______________ Fax No: ___________
E-mail Address: _____________________________________
No. of Black Belts: ____ No. of Gup Students: ___ Total No. of Students: ___
(If you have more than one dojang/club affiliated with you, complete the details above and attach a list of the names of the present instructors and the areas of all your affiliated dojang/clubs.
Please return to:
Grandmaster Vohra's International Martial Arts HQ
Ilkeston Road, Nottingham, NG7 3FX, England
Tel: +44 (0)115 9780439 Fax: +44 (0)115 978 5567
E-mail: info@martialartsvohra.com
|
