www.falkirkjujitsuclub.co.uk

In completion of this form for registration to the World Ju-Jitsu Federation, I accept that participation in a martial art carries the risk of serious injury and I hereby exonerate the World Ju-Jitsu Federation from losses, either personal, or of articles, or injuries of any nature or cause whatsoever. I further declare that I am fit to train in the martial arts.

I understand and accept all of the above

Title: Mr Mrs Miss Mast

First name: Last name:

Address 1:

Address 2:

Post Code:

Town/City: Country: Scotland

Name and Location of Club: Falkirk Kempo Ju-Jitsu Club.

Club Number: 100/3031

Tel: Occupation: (if student please indicate)

Date of Birth: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / January Febuary March April May June July August September October November December / 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920

Registration/Insurance Expiry Date:

Please indicate below if your application for renewal is for Senior or Junior Membership. Junior applicates are under the age of 18 and require a signature or parent or guardian (See Sensei)

Senior Registration
Junior Registration

Please complete all sections of this form. Applications not fully completed cannot be processed.