Application for dan and kyu grades

APPLICATION FOR DAN AND KYU GRADES

AIKIDO WITH MIND AND BODY COORDINATED

(FILL IN ALL INFORMATION BELOW THIS LINE.

PLEASE PRINT OR TYPE.)

DO NOT WRITE HERE.

FOR OFFICIAL USE ONLY.

CERTIFICATE NO _____________________

GRADE GIVEN: ________DAN _______KYU

MEMBERSHIP CARD NO.:	DATE OF MEMBERSHIP:
NAME:	DATE OF BIRTH:
ADDRESS:	SEX: FORMCHECKBOX FFFFFFFF0100000000000000000000000000000000000000000000000000000000000000 Male FORMCHECKBOX FFFFFFFF0100000000000000000000000000000000000000000000000000000000000000 Female
OCCUPATION: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	NATIONALITY: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000
PRESENT RANK: FORMCHECKBOX FFFFFFFF0100000000000000000000000000000000000000000000000000000000000000 FORMTEXT     FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 DAN FORMCHECKBOX FFFFFFFF0100000000000000000000000000000000000000000000000000000000000000 FORMTEXT     FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 KYU	NAME OF DOJO:
	INSTRUCTOR:
DATE PRESENT RANK OBTAINED: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	WHERE PRESENT RANK OBTAINED: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000
DATE OF EXAMINATION: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	EXAMINER’S SIGNATURE:

I HEREBY MAKE MY APPLICATION FOR FORMCHECKBOX FFFFFFFF0100000000000000000000000000000000000000000000000000000000000000 FORMTEXT     FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 DAN FORMCHECKBOX FFFFFFFF0100000000000000000000000000000000000000000000000000000000000000 FORMTEXT     FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 KYU.

SIGNATURE:__________________________________

APPLICATION FOR KI DEVELOPMENT GRADES

SHIN SHIN TOITSU DO

(FILL IN ALL INFORMATION BELOW THIS LINE.

PLEASE PRINT OR TYPE.)

DO NOT WRITE HERE.

FOR OFFICIAL USE ONLY.

CERTIFICATE NO _____________________

GRADE GIVEN: ________DEN _______KYU

MEMBERSHIP CARD NO.: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	DATE OF MEMBERSHIP: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000
NAME: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	DATE OF BIRTH: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000
ADDRESS: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	SEX: Male Female
OCCUPATION: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	NATIONALITY: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000
PRESENT RANK: FORMTEXT     FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 DEN FORMTEXT     FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 KYU	NAME OF DOJO:
	INSTRUCTOR:
DATE PRESENT RANK OBTAINED: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	WHERE PRESENT RANK OBTAINED: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000
DATE OF EXAMINATION: FORMTEXT       FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000	EXAMINER’S SIGNATURE:

I HEREBY MAKE MY APPLICATION FOR FORMTEXT     FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 DEN FORMTEXT     FFFFFFFF00000000000000000000000000000000000000000000000000000000000000000000 KYU.

SIGNATURE:__________________________________

Дата добавления: 2015-11-04