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Join SKISA

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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