Change In Circumstance Renewal Form - British Karate Kyokushinkai printable pdf download

BRITISH KARATE KYOKUSHINKAI

CHANGE IN CIRCUMSTANCE RENEWAL

(Form BKK L4/

)

R2016

SENIOR RENEWAL (16 YEARS AND OVER) FEE: For 2016/2017 See Form LS 2016

JUNIOR RENEWAL (UNDER 16 YEARS) FEE: For 2016/2017 See Form LS 2016

Please tick box above as appropriate

This form should be completed in BLOCK LETTERS and sent with your renewal fee to

LINDA KEAVENEY, 58 HIGHFIELD ROAD, CHELMSFORD, CM1 2NQ

Cheques and Postal Orders should be crossed and made payable to the "BKK".

……………………………………………………………………………

Family name________________________________ First name(s) in full____________________________________

Address_________________________________________________________________________________________

Tel number__________________ Fax number ____________________ E mail address________________________

Number of last License________________ Expiry Date_____________Club where registered__________________

Date of Birth___________________ Are you an Instructor or Student __________________Grade_____________

How many years have you been registered with the BKK_________ Have you transferred to another Club: Yes/No

If Yes please give Club Name_______________________________________________________________________

Occupation__________________________________________________ IFK Membership No ___________________

Have you any criminal convictions? Yes/No. If yes please give details_____________________________________

Date of this renewal application____________________________ Fee enclosed____________________________

Have you been absent from training since expiry of your last licence?

Yes/No

If Yes please give dates_________________________________________________________________

To be signed by the Club Secretary.

I confirm that the details above are correct to the best of my knowledge

Signed_______________________________________ Dojo Name_________________________________________

Club Secretary's Name: _________________________________________________________________

Date________________

Liam Keaveney/BKK/senior/junior renewal/C/Jan 2016

Rate for Existing Students Returning to Training

Existing BKK License

Juniors

Seniors

Senior/Junior Renewals 1st February 2016

18.00

32.00

Renewals during June to September 2016

15.00

25.00

Renewals during October 2016 to January 2017

9.00

15.00

Change In Circumstance Renewal Form - British Karate Kyokushinkai