Associate Registration

Shito-ryu registration

Shito-Ryu

Membership Registration Form

Salutation

Full Name

Date of Birth

Membership type

Affilation number

Website

Recommended By

Association Name

Date of incorporation

Mobile Number

Email ID

Contact Number

Street line 1

Street line 2

Landmark

Country

State

City

Pincode

Qualification

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Sr no.	Qualification Details	Action

Achievements

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Sr no.	Sports Achievements	Action

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Date

Place

Full Name

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I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE, FURTHER, I DO HEREBY, FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE RELEASE AND FOREVER DISCHARGE ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES WHICH I MAY HAVE OR WHICH MAY HEREAFTER ACCRUE TO ME AGAINST THE SHITO-RYU KARATE ASSOCIATION OR THEIR RESPECTIVE OFFICERS, AGENTS, REPRESENTATIVES, SUCCESSORS AND/OR ASSIGNS, FOR ANY AND ALL DAMAGES WHICH MAY BE SUSTAINED AND SUFFERED BY ME IN CONNECTION WITH MY FEDERATION WITH OR ENTRY IN THE SPORTS ACTIVITIES ASSOCIATED WITH SKA ADDITION, BY MY SIGNATURE, I CERTIFY I UNDERSTAND THAT SUBMISSION OF A COMPLETED APPLICATION AND THE APPROPRIATE.