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Amateur
Martial Associations & WAKO 66 Chaddesden Lane, Derby, DE21 6LP Tel: 01332 663 086 Fax:01332 280 286 Registration Officer: Christine |
MEMBERSHIP APPLICATION
MASTER AND VISA CARDS ACCEPTED
Instructors:
Membership, Personal Accident insurance, Public liability, Indemnity & Dental
| £5 million cover: | £55.00 | £………….. |
Club Registration:
| £5.00 | £………….. |
Students:
Membership, Personal Accident insurance, Liability, & Dental
| Seniors Over 16: | ring office | £………….. |
| Juniors Under 16: | ring office | £………….. |
Merchandise:
| Record Books - Card | £1.00 | £…………… | Bomber Jackets | Call | £…………… |
| Record Books - Leather | £3 | £…………… | Karate Gi's | call | £…………… |
| Badges (Union, Euro, WAKO) | £1. | £…………… | Taekwondo Suits | call | £…………… |
| Dan Certificates | £20.00 | £…………… | Mandarin suits | call | £…………… |
| Student Certificates | £1.00 blanks | £…………… | JuJitsu Suits | call | £…………… |
| Track Suits | from £40 plus £5 p&p contact 07939289711 | £…………… | Coloured Belts | call | £…………… |
| T-Shirts | call | £…………… | Gloves, mitts, pads, etc. on request | £…………… |
| Today's Date: ..…/……/…… | Amount Enclosed: £............... |
| Mastercard or Visa No: ……………………………… | Issue No if switch: …….......... | Expiry Date: …… |
| Name/Address to be sent to: | CLUB No: | Phone: |
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