Kenseikan Karate
ABN:- 15 337 942 098
To:- The Secretary
Kenseikan Karate
P.O. Box 2344. Carlingford
SYDNEY, NSW. 2117
AUSTRALIA
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Name of National Chief Instructor: |
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Our dojo recognizes KKI as it’s National governing body in and is in accordance with the purposes and objectives of KKI. We hereby submit our application along with the details and credentials of our club. We understand that only members of Registered Dojo can compete and/or participate in all KKI activities and events.
Upon acceptance as members, we will respect and abide by the KKI Constitution, Rules and Regulations and the decisions of the KKI Management Committee. We understand we must carry professional indemnity and public liability insurance, which can be arranged through the KKI. We will fully co-operate in the development of Traditional Martial Arts in Australia and Internationally
Signed: _________________________________ Title: __________________________________
Please check that you have included all attachments as listed on “Details of Applicant Dojo” form.
Membership fee of new member Dojo $100.oo or $50:oo renewal can be paid by:-
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Direct Deposit (preferred) to:- Kenseikan Karate Australia Commonwealth Bank Australia BSB No. 06 2300 Account No. 1016 1530 For international deposits Swift Code:- ctbaau2s (Please attach copy of receipt) |
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Cheque payable to:- Kenseikan Karate Australia |
This dojo has been accepted for membership in accordance with the Kenseikan Karate International Constitution.
Date accepted by Management Committee: ______________________________
Signed: ____________________________ Position Held: _______________________________
Kenseikan Karate
Type of Club:
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Incorporated Association |
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Unincorporated Association |
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Private School / Club / Group |
Qualifications of Dojo Instructor:
Dan Grade Level: ___________________________________________________________________
Certified by whom: ___________________________________________________________________
Style-base: ___________________________________________________________________
Insurance Company Name and Contact Phone No.: _________________________________________
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Please attach copies of:
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Dan Certificate |
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Character reference |
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Current Senior First Aid Certificate |
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Level 1 Coaching General Principles Certificate or Level 1 Sports Specific – Karate Certificate |
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Child Suitability Card or equivalent for your State. |
Number of Registered Individual Members at your Dojo: _________________________________________
Please list interests of you dojo:
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Local Competition |
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Referee/Judging/Officiating accreditation |
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Regional Competition |
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Teaching/Coaching accreditation |
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National Competition |
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Traditional Karate Seminars/Workshops/Camps |
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International Competition |
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Traditional Kobudo Instruction |
Please list other Karate/Martial Art Organisations where membership is held:
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Address of Dojo
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