Membership Application

APPLICANT INFORMATION

Name:*

Date of birth:*

Phone:*

Email:*

Current Street & Suburb address (your membership card and Member's Page password will be sent to this address):

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Membership Number:

Membership Type*

New Membership
Renewal

Current Grade:

Kyu	Dan

Date last grading:

Home Dojo:

EMERGENCY CONTACT

Name:

Phone:

Relationship:

Current Street & Suburb address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

DECLARATION

I apply to be accepted as a member of Aikido Yuishinkai Australia and to be registered as a student. I understand that my studentship & membership must remain current at all times. I agree to be bound by the Memorandum of Agreement and the rules & regulations of Aikido Yuishinkai Australia and will abide by the Directions of the organisation. I also understand that if I fail to do the above I may be required to leave. I believe that I am healthy and capable of Aikido training, am aware of the Aikido Yuishinkai Australia Student Code of Conduct and will fully respect the rights of others. I understand and have considered that Aikido is a martial art that involves physical training and accept that practice and participation involves the risk of permanent, serious personal injury. I will take all due care and agree that no liability for personal injury shall attach to Aikido Yuishinkai Australia, or any student, instructor, member, employee, official, director, volunteer of either Aikido Yuishinkai Australia or its constituent Dojos.

Signature of Applicant:*

*Typing your name here constitutes signature

Head Dojo Instructor:

(only required for new memberships)

Parent/Guardian’s signature:

*Typing your name here constitutes signature

Print name:

(if applicant is under 18 years)

Date*

PAYMENT DETAILS FOR ANNUAL MEMBERSHIP

The chief instructor of Yuishinkai Australia, Peter Kelly, as Maruyama Sensei’s representative, has requested that all payments for annual membership be made into the account below:

Adult ($100) [if joining during the year the rate is $25 per quarter]
AikiKid ($30)

PLEASE PAY THE FEE TO THE ACCOUNT BELOW BY BSB:
Account Name: Peter Kelly
BSB: 633-000
Account: 145 094 249
Description: Membership "your name here"