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APPLICATION FORM
USE BLOCK CAPITAL LETTERS ONLY
SURNAME Mr/Mrs/Miss ___________________________________
FIRST NAME(S) ________________________________________
ADDRESS _____________________________________________________
POST CODE __________________ GRADE __________________
DATE OF BIRTH _______/________/____________
CLUB NAME (Name you would like to appear on the Affiliation Certificate)
_____________________________________________________
NUMBER OF STUDENTS ______________________
TELEPHONE No _____________________________
Please include with application copies of your last rank certificates (instructor only)
I wish to affiliate the above club(s) to S.K.I.S.A. and enclose the annual affiliation fee of ____________ (affiliation runs from January 1st to January 1st of the following year regardless of the date taken out).
Please make cheques payable to: S.K.I.S.A. or do a direct deposit into:
SKISA Bank Details
A/C SKISA
NEDBANK
BR CODE: 17952600
A/C NO: 2795007762
Signed ________________________________ Date __________
Please send this form with proof of payment to:
SKISA HQ kyoshi@ski-karate.com
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