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- PERSONAL INFORMATION -
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| Last Name |
First Name |
Middle Initial |
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| Street Address |
City |
State |
Zip |
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Occupation / Employer
(Students, give your school name, grade, and area of study) |
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| Date of Birth (Month/Day/Year) |
Age |
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| Marital Status |
Name of Spouse |
Name of Child(ren) |
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- CONTACT INFORMATION -
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Home Phone
(primary contact #?) |
Business Phone
(primary contact #?)
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Mobile/Page#
(primary contact #?) |
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| E-Mail Address |
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- EMERGENCY CONTACT -
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| Person to contact in an emergency |
Relationship to you |
Contact's Phone |
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- EXPERIENCE -
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| Prior Kendo and/or Iaido Training (please include date(s) and location(s)) |
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| Kendo Rank (Dan) |
Iaido Rank (Dan) |
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Briefly describe any other previous training in martial arts, western combat sports, or any sports
(please include any rank/title held, and dates & locations) |
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- DISCLAIMER -
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| I, ____________________ wish to participate in the Kendo / Iaido training being offered by the Dallas / Fort Worth Kendo & Iaido Kyokai. I hereby acknowledge as a condition of my membership that I shall hold neither the Dallas / Fort Work Kendo & Iaido Kyokai, nor the Southwestern United States Kendo & Iaido Federation, nor the All United States Kendo Federation, nor any of the instructor or student members of these organizations named herein, liable for any damages or injuries I may sustain from participation in the aforementioned activities. |
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Signature
(New Member) |
Signature
(Minor’s Parent/Guardian) |
Today's Date
(Month/Day/Year) |
| ____________________________ |
____________________________ |
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