IWAMA RYU GB

MEMBERSHIP APPLICATION FORM

FORNAME(S): SURNAME:
HOME ADDRESS:
TWO PASSPORT TYPE
TOWN: PHOTOS
COUNTY: MUST ACCOMPANY
POSTCODE: THIS APPLICATION
COUNTRY:
PHONE (HOME): PHONE (WORK):
GENDER (M/F): DATE OF BIRTH: / /

Zenshin Aikido Club

AIKIDO DETAILS:
DATE STARTED WITH THIS CLUB: / /___ DATE OF BIRTH: / /
CURRENT GRADE: DATE AWARDED:
AWARDED BY:
OTHER MARTIAL ARTS
ART: GRADE:
ART: GRADE:

DO YOU HOLD A RECOGNISED AIKIDO COACHING QUALIFICATION? YES/NO

(If YES please give details):
EXPIRY DATE: / /

DO YOU HOLD A FIRST AID CERTIFICATE RECOGNISED BY THE BRITISH AIKIDO BOARD? YES/NO
(If YES please give details):

AILMENTS YES/NO
(If YES please give details):
EXPIRY DATE: / /

DECLARATION AND DATA PROTECTION ACT

I WISH TO BECOME A MEMBER OF I.R.G.B. IF ACCEPTED I AGREE TO BE BOUND BY THE CONSTITUTION AND BYLAWS OF THE
ORGANISATION. I UNDERSTAND THAT THESE INDEMNIFY T.A.I.R.G.B. AGAINST ANY INJURY OR LOSS (INCLUDING LOSS OF PERSONAL
EFFECTS) WHICH I MIGHT SUSTAIN THROUGH THE PRACTISE OF AIKIDO OR OTHERWISE.
IT IS A REQUIREMENT OF THE DATA PROTECTION ACT 1998 THAT PERSONS GIVE THEIR WRITTEN AUTHORISATION TO HAVING THEIR
DETAILS RECORDED. BY SIGNING BELOW YOU ARE ALLOWING YOUR DETAILS TO BE RECORDED ON THE ORGANISATION DATABASE
AND THE BRITISH AIKIDO BOARD DATABASE. THESE DATABASES ARE NOT DISTRIBUTED TO THIRD PARTYS AND ARE NOT USED FOR
NPN-AIKIDO RELATED FUNCTIONS. FAILURE TO SIGN BELOW WILL MEAN YOU CANNOT BE A MEMBER OF THESE ORGANISATIONS.

SIGNED: DATE: / /
(Signature of Parent or Guardian if under 16):

THIS SECTION MUST BE COMPLETED BY YOUR CLUB REPRESENTATIVE BEFORE RETURNING TO THE REGISTRAR:
CLASS OF MEMBERSHIP SEN [ ] JUN [ ] CON [ ] AMOUNT PAID £________ INITIALLED

IRGB USE ONLY: ACCEPT: Y/N IRGB NO: BAB NO: ISSUE DATE: 01 / /

Return to: Steph Turner, 65 Alder Crescent, Parkstone, Poole, Dorset, BH12 4BE