GOJU RYU KARATE I SELF … · TERMS AND CONDITIONS OF MEMBERSHIP 1. DEFINITIONS Unless otherwise...
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SENSEi EMMA WENꜨEL 4 th Dan Instruor 93 Randpark Drive Randpark Ridge 2194 Cell: 083681 9918 Tell: 011 791 0765 Fax: 086 551 2607 [email protected] .SEISHINMꜲ.CO. MARTIAL ARTS AÊDEMY GOJU RYU KARATE I SELF DEFENSE I WKF SPORT KARATE STUDENT PARTICULARS First Name/s I I Last Name I I.D Number I I Relation to I Member Date of Bih I YY / MM /DD Guaians I Postal Address Code I Physical Address I Email Address I Please PRI NT Clearly Cellphone I Telephone I Fax I Medical Ailments MENT METHOD Cash 1 E I Joining Fee I I Terms I I Monthly I I Annual I I EMERGENCY CONTACTS D oor I I Tell No. I I Ne Of Kin I I Tell No. I I Date Sta ed I ___________ _ Sig nat ure * I _ _ _ _ _ _ _ _ _ _ _ _ I HOWDID YOU HEAR ABOUT US? _ I ________ _ I *Please Note: that signature of this rm constitutes acceptance of the terms and conditions aached to this rm. Please initial the back of this rm in the space provided.
Transcript of GOJU RYU KARATE I SELF … · TERMS AND CONDITIONS OF MEMBERSHIP 1. DEFINITIONS Unless otherwise...
SENSEi EMMA WENTZEL 4 th Dan Instructor 93 Randpark DriveRandpark Ridge2194Cell: 083 681 9918 Tell: 011 791 0765 Fax: 086 551 2607 [email protected]
WWW.SEISHINMAA.CO.ZA MARTIAL ARTS ACADEMY
GOJU RYU KARATE I SELF DEFENSE I WKF SPORT KARATE
STUDENT PARTICULARS First Name/s I I Last Name II.D Number I I Relation to
IMember
Date of Birth I YYYY / MM /DD Guardians IPostal Address Code I
Physical Address IEmail Address I Please PRI NT Clearly
Cellphone I Telephone I Fax I Medical Ailments
PAYMENT METHOD Cash
1EFT I
Joining Fee I I Terms I I Monthly I I Annual I I
EMERGENCY CONTACTS
D octor I I Tell No. I I Next Of Kin I I Tell No. I I
Date Started .. I ___________ _
Signature* .. I ____________IHOW DID YOU HEAR ABOUT US? _I _________ I
*Please Note: that signature of this form constitutes acceptance of the terms and conditions attached to this form.Please initial the back of this form in the space provided.
Emma Wentzel
Emma Wentzel
their
