subject_line
Ottawa JKA Membership Registration
Member Information
CJKF Registration Number
Dojo Name
*
Ottawa JKA
JKA Shinseikan
Markham JKA
Brad Jones Shotokan
Scarborough JKA
Please email me updates
First Name
*
Last Name
*
Gender
*
Male
Female
Birthday
(YYYY/MM/DD)
*
+
Address
*
City
*
Province
*
AB
BC
MB
NB
NL
NS
ON
PE
QC
SK
NT
YT
NU
Postal Code
*
Country
*
Canada
United States
Phone
(613-123-4567)
*
Email Address
Current Ranking & Qualification
Current Rank
*
9th Kyu
8th Kyu
7th Kyu
6th Kyu
5th Kyu
4th Kyu
3rd Kyu
2nd Kyu
1st Kyu
Shodan
Nidan
Sandan
Yondan
Godan
Roku Dan
Nana Dan
Instructor Qualification
Class A
Class B
Class C
Class D
Examiner Qualification
Class A
Class B
Class C
Class D
Judge Qualification
Class A
Class B
Class C
Class D
History of Ranking & Qualification
Enter date in this format YYYY/MM/DD
(Example: 1997/11/21)
Ranking History
Date Achieved
Registration No.
Shodan
Date Achieved
Registration No.
Nidan
Date Achieved
Registration No.
Sandan
Date Achieved
Registration No.
Yondan
Date Achieved
Registration No.
Godan
Date Achieved
Registration No.
Rokudan
Date Achieved
Registration No.
Nanadan
Date Achieved
Registration No.
Instructor Qualification
Date Achieved
Expiry Date
Class A
Date Achieved
Expiry Date
Class B
Date Achieved
Expiry Date
Class C
Date Achieved
Expiry Date
Class D
Date Achieved
Expiry Date
Examiner Qualification
Date Achieved
Expiry Date
Class A
Date Achieved
Expiry Date
Class B
Date Achieved
Expiry Date
Class C
Date Achieved
Expiry Date
Class D
Date Achieved
Expiry Date
Judge Qualification
Date Achieved
Expiry Date
Class A
Date Achieved
Expiry Date
Class B
Date Achieved
Expiry Date
Class C
Date Achieved
Expiry Date
Class D
Date Achieved
Expiry Date
Technical Training Attended
(Example: 2010/08/19-22: Koyo Camp, Ottawa)
0/800 characters
Waiver Forms (please click link below to print, sign and hand-in your waiver forms)
Downloadable Waiver Forms
Privacy Statement:
Information collected is safely transmitted using SSL technology and stored in a secured database. It is used strictly for Ottawa JKA registration purposes and is not accessible by a third party.