Update an Existing Membership

EXISTING Membership Type

Please state current membership*

Single Membership Junior at £30 per month
Single Membership Senior at £40 per month
Combined Membership 1 Adult + 1 Child at £60 per month
Combined Membership 1 Adult + 2 Children at £80 per month
Combined Membership 1 Adult + 3 Children at £100 per month
Combined Membership 2 Adults + 1 Child at £80 per month
Combined Membership 2 Adults + 2 Children at £100 per month
Combined Membership 2 Juniors at £55 per month
Combined Membership 2 Seniors at £75 per month
Combined Membership 3 Juniors at £75 per month
Combined Membership 3 Seniors at £100 per month
Combined Membership Special at £110 per month

REQUIRED Membership Type

Please select required membership*

Member's Information

Please complete for all members of the required membership.

Name*

First Last

Date of Birth*

Name*

First Last

Date of Birth*

Name*

First Last

Date of Birth*

Name*

First Last

Date of Birth*

Name

First Last

Date of Birth

Parents Name*

Prefix First Last

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email Address*

Enter Email Confirm Email

Contact Number*

Alternative Number

Medical and Emergency Contact

Medical Conditions*

Do you have any medical conditions or allergies we should be aware of:

No
Yes

About Your Medical Condition(s)*

Emergency Contact Name

First Last

Emergency Contact Number

Payment

Payment*

IMPORTANT NOTE This will cancel and replace any existing subscription currently in place with Kyudokan.

Securely pay for your subscription via credit or debit card.
You hereby authorise Kyudokan to set up a continuous monthly payment on the card entered below for the selected fees pertaining to this membership.

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Card Details

Cardholder Name

Annual Insurance*

By clicking this box I agree, IN ADDITION to the monthly costs subscribed hereto, that on the 1st August EVERY YEAR, a single sum of £24 PER PERSON UNDER THIS MEMBERSHIP will be debited from the above card to cover my annual martial arts insurance.

Image Rights

Photograph / Video Consent*

Please can you confirm your approval below for club photos to be taken during events, which may be used on our website, social media, or for promotional literature:

Yes I am happy for this
No please do not include me in this

Declaration*

By checking this box, I am aware and accept that the practice of martial arts is a contact activity/sport, which involves the risk of injury and I agree to abide by the association rules.

Comments

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Kyudokan Goju Ryu Karate Do

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