Affiliation form
Name: （ ）	
Home Address: 
	Your  photograph

	Dojo: Address: 

Mobile: 	
Please fill in  ×  on　(　　).
(　　) Partner  Dojo 　(　　) Branch chief of your country　 (　　) Individual member

Date of Birth：
Gender : 
Nationality：  
Occupation ：
e-mail：
Website：
Your Karate style(Ryu-ha):
Self introduction  of your Dojo, please. 
"Dojo" means the place where you regularly teach  Karate exists. You need not be an owner of  the facilities ) 

Reason and purpose to do affiliate to G.I.K.K.U   (or  J.I.K.K.U )：

Hope to G.I.K.K.U  (or  YUZENKAI Japan) 

Your  Main  Karate Background –History

Black Belt Dan	Dojo	Year 	Master　name	

				

				
I hope  that you attach  some photographs of your activity and your Dan certificate and useful materials I can understand you