EDO MACHI-KATA TAIHO JUTSU

MEMBERSHIP PETITION

INSTRUCTIONS: 1. Fill out the three-page membership petition as completely as possible. (The petition

includes text fields so you may fill out the form directly on your computer.)

2. Print and sign the completed petition form.

3. If you currently hold a yudansha rank in any martial art, attach a photocopy of your most

recent certificate.

4. Inform the listed references that they may be contacted directly by representatives of Eda Machi-kata Taiho Jutsu with questions regarding your character and involvement in the martial arts.

5. Mail the completed petition and any attachments to the director or your regional representative. Please contact the director by e-mail for the current mailing address.

6. You may also submit a petition form directly by e-mail.

7. Please check out our website.

PERSONAL INFORMATION

Name:

Street: ------------------------

City: State: ---

Apt:

Postal Code:

Age:

Country: _______________ _ Telephone: ______________ _

E-mail:--------------------------------------

Education (Check one)

Other:

Occupation:

High DSchool

Some DCollege

College DGraduate

Post- D Graduate

Have you ever been convicted* of a violent crime or a sexual offense? If yes, provide details including charges and dates below:

Military D

Yes D NoO

* Conviction of a crime does not automatically exclude you from membership. The type of crime and when it occurred will bereviewed and taken into consideration.