Kokusai Nippon Budo Kai / Jikishin Kai International ...db.knbk.org/media/documents/44 KNBK Dojo...

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Kokusai Nippon Budo Kai / Jikishin Kai International Membership Outline Kokusai Nippon Budo Kai membership serves as connection to the Organization and the traditions it represents, becoming a member and participating in the certification process that accompany these disciplines, contributes toward fostering the arts for future generations. All KNBK / JKI memberships (Yukyusha, Yudansha and Dojo) are based on the calendar year; all renewal registrations are due on or before March 1 st of each year. All memberships are to be submitted from the Instructors to a Shibu Dojo or a Honbu Dojo Sponsor for the KNBK Secretary Treasurer. (Example: If a person is registered for the first time in June 2009, that membership is only valid for the remaining months of 2009, he/she is to register for the 2010 calendar year on or before March 1 st of 2010. All currently registered members are considered valid and current until the March 1 st deadline) New members: Individual New individual members should register by submitting a “KNBK Membership form” at the time of their first grading. The “KNBK membership form” should only be submitted one time; The “KNBK membership form” should be retained at the Shibu Dojo where it was submitted. The Shibu Dojo responsible for your membership will then submit a “New student-Kyu test application” form to the KNBK treasurer. The Dojo Roster will then be amended with the new student information and a permanent KNBK Yukyusha ID Card will be issued along with the requested first certification. Current Members: Individual Existing members submit their renewal through their dojo / Instructor to the Shibu Dojo or Honbu Dojo Sponsor via a completed “Dojo Membership Roster”, all KNBK dojo have a copy of their current “Membership Roster”, and this roster is reconciled with the copy at Honbu Dojo. In January, the KNBK Treasurer sends out the current member roster to each Shibu Dojo or Honbu Dojo Sponsor, at this time the Shibu Dojo will update the roster with current/renewals and inactive members while submitting the annual member dues to the Honbu Secretary. Members who grade to Shodan-ho or Shodan while registered as Yukyusha: Do not need to re- register; a Yudansha Member Card will be issued upon the successful completion of the Shodan . He/she is then required register as a Yudansha during the next registration.

Transcript of Kokusai Nippon Budo Kai / Jikishin Kai International ...db.knbk.org/media/documents/44 KNBK Dojo...

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Kokusai Nippon Budo Kai / Jikishin Kai International Membership Outline

Kokusai Nippon Budo Kai membership serves as connection to the Organization and the traditions it represents, becoming a member and participating in the certification process that accompany these disciplines, contributes toward fostering the arts for future generations.

All KNBK / JKI memberships (Yukyusha, Yudansha and Dojo) are based on the calendar year; all renewal registrations are due on or before March 1st of each year. All memberships are to be submitted from the Instructors to a Shibu Dojo or a Honbu Dojo Sponsor for the KNBK Secretary Treasurer. (Example: If a person is registered for the first time in June 2009, that membership is only valid for the remaining months of 2009, he/she is to register for the 2010 calendar year on or before March 1st of 2010. All currently registered members are considered valid and current until the March 1st deadline)

New members: Individual New individual members should register by submitting a “KNBK Membership form” at the time of their first grading. The “KNBK membership form” should only be submitted one time; The “KNBK membership form” should be retained at the Shibu Dojo where it was submitted. The Shibu Dojo responsible for your membership will then submit a “New student-Kyu test application” form to the KNBK treasurer. The Dojo Roster will then be amended with the new student information and a permanent KNBK Yukyusha ID Card will be issued along with the requested first certification.

Current Members: Individual Existing members submit their renewal through their dojo / Instructor to the Shibu Dojo or Honbu Dojo Sponsor via a completed “Dojo Membership Roster”, all KNBK dojo have a copy of their current “Membership Roster”, and this roster is reconciled with the copy at Honbu Dojo. In January, the KNBK Treasurer sends out the current member roster to each Shibu Dojo or Honbu Dojo Sponsor, at this time the Shibu Dojo will update the roster with current/renewals and inactive members while submitting the annual member dues to the Honbu Secretary. Members who grade to Shodan-ho or Shodan while registered as Yukyusha: Do not need to re-register; a Yudansha Member Card will be issued upon the successful completion of the Shodan. He/she is then required register as a Yudansha during the next registration.

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Yudansha Members: Individual current members. All current Yudansha will submit an annual membership renewal form called “Yudansha Member Registration and Renewal“, the Yudansha are the future of the organization, by keeping track of our potential instructor core, we can plan for healthy growth and assist our Yudansha in fulfilling their goals.

Yudansha Members: Promotional Letter of Intent Attached to the previous form is the “Promotional Letter of Intent”. Any yudansha who intends to promote or test for advancement (to grade Nidan and above) in the coming calendar year, must complete this section of the “Yudansha Member Registration and Renewal form”. This process is in place to enable the KNBK sufficient opportunity to provide any needed technical, educational or organizational information.

Inactive Kyu Members: Names will be marked inactive for students who are no longer training or taking a leave of absence. Member ID numbers and Kyu ranks can be considered “inactive” for up to three years, after which time they will be purged from the Dojo roster. If a student returns to training within the three year inactive period, he may re-activate his/her member ID number and all previously awarded Kyu rank will be accepted as valid towards future training goals.

Inactive Yudansha Members: Yudansha who wish to return from inactive status must apply for current membership with their Shibu Dojo or Honbu Dojo Sponsor, the re-activation of a Yudansha Member will be handled on a “case by case” basis.

Dojo Membership: New New Dojo membership applications can be submitted at any time during the calendar year, please contact a Shibu Dojo or your Honbu Sponsor requesting a “New Member Dojo Application and Guideline”.

Dojo Membership: Renewals Shibu Dojo and Member Dojo renewal are submitted with a “Dojo Membership Renewal Form”; please submit this form along with your updated Membership Roster.

Kenkyukai are not required to submit an annual Dojo registration. Individual members of any recognized KNBK Kenkyukai are listed as members of their sponsoring Shibu dojo, Member dojo or Honbu Sponsor.

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Official Only: ID# __________

Kokusai Nippon Budo Kai / Jikishin Kai International KNBK Membership / Renewal Form

New Member Kyu Membership ----- $ 15.00 (Yearly) Renewal - Your Membership ID #: ___________ Dan Membership ----- $ 25.00 (Yearly) Karate-Do Iai-Do and Jo-Jutsu Renewal deadline 03/01, add a late fee of $5 for Kyu and $10 for Dan if sent after the deadline. Name: _________________________________________________________ Male Female (Last) (First) Address: __________________________________________________________________ Apt: __________ City: ____________________________________ State: _____________ Zip Code: ____________________ Home Phone: (______ ) ________-_____________ Dojo Phone: (________) ________-_____________ Dojo Name: _______________________________ Instructor Name: _________________________________ Dojo Address: ________________________________________________________ Suite: _______________ City: __________________________________ State: ______________ Zip Code: _____________________ Email : __________________________Martial Arts Ranks: ________________________________________

PARTICIPATION AGREEMENT In consideration of my use of the dojo, I hereby agree to the following Mission STATEMENT and RULES:

Mission Statement

The Kokusai Nippon Budo Kai / Jikishin Kai Int. strives to be the most reputable and respected organization dedicated to the promotion of the Martial Arts Spirit and Tradition. In order to achieve this goal, it is the responsibility or each member to seek a sincere commitment to self-improvement of mind and body in accordance with the teachings of our martial art tradition. Kokusai Nippon Budo Kai / Jikishin Kai Intl. promotes an environment of leadership training wherein a very important precept is taught: that everyday life presents significant obstacles and personal challenges which are to be viewed as nothing more than opportunities to succeed, or win. This is the Samurai’s path to a victorious life.

Rule 1, I will show true and proper courtesy and respect for my instructor, senior and junior students, the dojo, and my weapon(s). 2, I am responsible for the proper use, care and safety of my weapon(s), clothing and equipment. 3, I will not engage in idle chatter during class time. 4, I am fully responsible for any loss, damage, or injury I incur while using the dojo, or while traveling to or from the dojo. I certify that I have read the mission statement, regulations set forth above in their entirety, that I understand them completely, and I understand them completely, and I agree to fully comply with them at all times. Signature: ______________________________________________________ Date: ___________________ (Parent or Guardian’s Signature if under 18 years old)

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Kokusai Nippon Budo Kai / Jikishin Kai International Organizational guidelines for Official Dojo Kenkyukai | Member Dojo | Shibu Dojo

KNBK Kenkyukai: Official study group. Becoming an Official KNBK Kenkyukai; the members of a recognized study group must become members of the KNBK through an established KNBK Member Dojo, Shibu Dojo or Honbu Dojo Sponsor. A “New Member Dojo Application” must be submitted and approved. A Kenkyukai should have 3 or more actively participating group members who are progressing under the instruction of (at minimum) a licensed KNBK Fuku Shidoin. Members should complete all organizational requirements of an individual member. KNBK Kenkyukai is required to submit all applications, dues and correspondence through the sponsoring Member Dojo, Shibu Dojo or Honbu Dojo sponsor. The study group leader will receive all documentation guidelines designed for Kenkyukai use. See: Kenkyukai summary.xls.

KNBK Member Dojo: An Official Member Dojo is fully accredited dojo representing the KNBK in a specified region, containing one or more licensed KNBK Shidoin or Shihan Dai. A member Dojo is entitled use of all of the organizational affiliation, artwork and documentation. A Member Dojo is to submit all applications, dues and correspondence through the sponsoring Shibu Dojo or Honbu sponsor. Member Dojo may conduct examinations up to the specified level of its chief instructor’s license. Member Dojo should commit to the use of all KNBK policies concerning registration and fee submissions as specified in the “Member Dojo Treasurers summary.xls”.

KNBK Shibu Dojo: Shibu or “Branch” dojo are to be recognized as a direct extension of the Honbu Dojo. Maintaining the integrity and accurately representing the Traditions is the first priority of a Shibu Dojo, every effort is made to convey the standards, spirit, compassion and heart of the KNBK / JKI history and leadership. Shibu Dojo are under the direction of a minimum Yondan/Doushi level Director, who actively participates in the organizational growth and the education of new Dojo and Kenkyukai. Shibu are expected to coordinate the technical education and advancement of its Members, Member Dojo and Kenkyukai in their branch or who submit correspondence to the KNBK through their branch office.

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(Unofficial) Kenkyukai: Study group (research society) An group of students who practice together on a regularly scheduled basis, without any official member dojo affiliation or KNBK / JKI membership. A dojo may choose to remain an unofficial Kenkyukai. Unofficial Kenkyukai should refrain from the use of any KNBK / JKI affiliation, artwork or documentation. Please refrain from any public advertizing using any affiliated KNBK / JKI images, logo or printed material referencing the KNBK / JKI and any of its leadership.

To become an official KNBK Dojo, you must submit the proper application for the chief instructor’s current level. If the chief instructor is not currently licensed, he/she needs to apply for an “Advanced Instructors License/Shidosha Menkyosho” or a “Shogo”. Upon successful completion of the Licensing, a Dojo application may be submitted to the Sponsoring Shibu Dojo or Honbu Dojo Sponsor.

An official KNBK Dojo will be clearly recognized on the Honbu Dojo website and listed in all of the national KNBK /JKI Newsletters. KNBK Dojo will be invited to participate in regional and national Gasshuku and Shidosha Koshukai. KNBK Dojo leaders are first considered to sit on the board of directors for the KNBK, are encouraged to host or instruct regional seminars on behalf of the organization. All student and membership inquiries sent to Honbu from any particular region are directed to the nearest official KNBK Dojo for instruction.

Honbu Dojo Sponsor: A certified Yudansha level instructor, assigned by Honbu Dojo to represent Members, Kenkyukai or Member Dojo who do not belong to a Shibu. The Honbu Sponsor acts as a Shibu dojo in the handling of applications and dues submissions, educational needs and training of Dojo near Honbu Dojo who are not a Shibu and who do not fall under the direction of a Shibu Dojo.

Please see the “New Dojo Membership Application and Guideline.pdf” for information about creating a new KNBK / JKI Dojo. A copy of this form is available at a Shibu Dojo or from a Honbu Dojo Sponsor.

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FOR CALENDAR YEAR

DOJO INFORMATION

Dojo Name:

Instructor’s Name: Rank:

Dojo Address:

City: States/Zip:

Country:

Phone #: Fax #:

E-mail address: Website address:

ADDRESS AT WHICH YOU WISH TO RECEIVE MAIL, IF DIFFERENT FROM ABOVE:

Name:

Dojo:

Address:

City: State/Zip:

Country:

Dojo Membership / Renewal Fee: Check: CC on file:

I, , on behalf of the applicant Dojo, hereby agree to accept all regulations, terms and conditions of membership set forth by the KNBK / JKI. I understand that future compliance with these conditions is a requirement for continued membership in the KNBK / JKI.

Instructor’s signature Date

MEMBER DOJO SHIBU DOJO

Dojo Membership Renewal Form

Kokusai Nippon Budo Kai / Jikishin Kai – International

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Kokusai Nippon Budo Kai / Jikishin Kai - International

Advanced Teaching Certification (Shidosha Menkyo Sho) Licensing requirements and overview

Fuku Shidoin (assistant teacher): Assistant Instructor

Sho-dan, minimum of 18 years of age. Currently leading or assisting instruction at a recognized KNBK /JKI Dojo or Kenkyukai (study group). Attended a minimum of 2 KNBK / JKI Gasshuku and 1 Shidosha Koshukai (instructor’s seminar). Submit a “Shidosha Menkyosho Application” for Advanced Instructors Certification, endorsed by a Shibu Dojo or Honbu Dojo sponsor. The first of three instructors licenses; is intended for newer yudansha who wish to be engaged in dojo and organizational growth, assist in teaching classes either for or in the absence of the dojo cho. A Shidosha with a Fuku Shidoin license may create and manage a recognized KNBK Kenkyukai (study group) under the supervision of a sponsoring Shibu Dojo or Honbu Dojo Representative. A Fuku Shidoin may request memberships for new students and provide grading for his/her Kenkyukai members up to and including yon-kyu. All membership and grading requests must be submitted through your sponsoring Shibu Dojo or Honbu Dojo sponsor.

Shidoin (teacher): Instructor

Nidan, Fuku Shidoin for a minimum of 2 years, at least 21 years of age. Currently leading or assisting in instruction at a recognized KNBK /JKI Dojo. Attended a minimum 4 KNBK / JKI Gasshuku and 2 Shidosha Koshukai (instructor’s seminar). Fostering good leadership skills with a focus on personal developments and teaching ability. Submit a “Shidosha Menkyosho Application” for Advanced Instructors Certification, endorsed by a Shibu Dojo or Honbu Dojo Sponsor. The second instructor license; is intended for yudansha who actively participate in Dojo leadership and instruction or who currently operate their own Kenkyukai and or assist in overseeing study groups and affiliated members. A Shidosha with a Shidoin license is entitled all of the permissions of a Fuku Shidoin, in addition a Shidoin may apply to become a “Certified Member Dojo”. A Shidoin may submit renewal and request memberships for new students and provide grading for his/her Member Dojo or Kenkyukai

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up to Ikkyu (1st kyu level). All requests must be submitted through the sponsoring Shibu Dojo or Honbu Dojo sponsor.

Shihan Dai (masters assistant): Advanced Instructor

Sandan, Shidoin for a minimum of 3 years, At least 25 years of age. Actively leading instruction at a KNBK /JKI Dojo. Possess a high degree of understanding and technical ability in your chosen discipline. Demonstrate a high degree of integrity, responsibility and compassion while actively assisting the KNBK and JKI in sharing traditional Budo with others in its vision of good will. Submit a “Shidosha Menkyosho Application” for an Advanced Instructors Certification and Examination, endorsed by a Shibu Dojo or Honbu Dojo Sponsor.

This final instructor license is intended for yudansha who; would like to become part of the organizational leadership structure and directors board, currently operate a Certified Member Dojo or Kenkyukai and or assist in overseeing Member Dojo, study groups or affiliated members. A Shidosha who is awarded Shihan Dai is entitled all of the permissions of previous licenses. A Shihan Dai, may request memberships for new students and provide grading for his/her Member Dojo or Kenkyukai up to Shodan. All requests must be submitted through the sponsoring Shibu Dojo or Honbu Dojo sponsor.

An Instructor certification process is important for any organization wishing to establish and maintain healthy growth. While becoming a Yudansha or “black belt” is an enormous undertaking in any discipline, becoming a Yudansha does not always equal becoming a qualified instructor. Our Instructor licensing program serves as a guide for the KNBK leaders, inspiring and educating our Yudansha to grow into mature knowledgeable instructors.

An increased responsibility accompanies each license, encouraging continued education and participation in regional and national training, while providing a clear definition of organizational duties, abilities and expectations.

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Shihan Dai, Shidoin and Fukushidoin Application Form

Applicant’s signature:

Kokusai Nippon Budo Kai / Jikishin Kai – International

Name:

Rank: Date promoted to current rank:

Dojo:

How many classes do you teach per week?

Do you sit on the testing committee at your dojo?

Are you the Chief Instructor of your dojo? Yes No

You are applying for (check one):

Fukushidoin: Shidoin:

Fukushidoin: yes no

You were recommended for this license by:

Name: Rank:

Dojo:

Is this person your instructor? Yes: No:

If no, explain their relationship to you?

I have enclosed a check: or credit card on file:

Todays date:

Shihan-dai:

You are currently: Shidoin: yes no

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Kokusai Nippon Budo Kai / Jikishin Kai Intl. Treasurers Guidelines

KNBK / JKI Annual Membership fees Dojo: Kenkyukai ($00.00) Member Dojo ($75.00) Shibu Dojo ($100.00) Members: Yukyusha ($15.00) Yudansha ($25.00) Kodansha ($25.00) Testing Fees are to be presented at or before the time of the exam for all grades up to and including Shodan. Valid and current membership is required for all exams. Shodan-ho and Shodan exams will not be approved without two or more years of concurrent membership. 7th thru 4th Kyu ($40.00)

3rd thru 1st Kyu ($50.00)

Shodan Ho ($100.00)

Shodan ($150.00) Skipping or bypassing Kyu grading is only allowed with permission from the KNBK leadership committee and is decided on a “case by case” basis, to be approved or declined upon joining the KNBK . Bypassing the membership guidelines and annual monetary responsibility to the organization is not permitted. Valid membership for a minimum of two full years is a requirement of all yudansha applicants.

Yudansha who wish to promote beyond Shodan are asked submit a “Promotional Letter of Intent” with their annual Yudansha renewal form along with a $50 application fee, this fee is applied towards the total of the certification, the remaining balance is due upon successful completion of the exam within the registration period. If you fail to successfully complete the exam, you are asked to retest after a six month training period. If you fail to attend or fail to successfully complete the applied for exam, you will be asked to submit a new application and testing fee during the next registration.

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Nidan ($250.00)

Sandan ($375.00)

Yondan ($500.00)

Godan ($650.00)

Rokudan ($800.00)

Nanadan ($1,000.00) Shidosha Menkyosho (Instructors License) Fuku Shidoin ($100.00)

Shidoin ($175.00)

Shihan Dai ($250.00)

Replacements: Yukyusha Member Card ($5.00) Yudansha Member Card ($10.00) Kyu Certificate ($5.00) Dan Certificate ($10.00)

Store Items: Patches: JKI “Jiki Shin” JKI “Crane Tsuba” Rank / Title shoulder patch Gold Wire Crane/Katabami Books: Flashing Steel (2nd Edition) Katsu Jin Ken (Living Karate) (Gold wire patch is was created for when brecommended for use at banquets or Dai N

($10.00) ($10.00) ($12.00) ($50.00)

($25.00) ($30.00)

usiness attire is required, they pin directly to the blue blazer ippon Butoku Kai events)

robin
Typewritten Text
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Typewritten Text
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Kokusai Nippon Budo Kai / Jikishin Kai – International

A Dojo applying to become a member of the Kokusai Nippon Budo Kai must

the applicant Dojo is a KNBK Shidoin or Shihan-Dai, the “Sponsor Informa-

Dojo as an official Member Dojo of the KNBK will be determined on a case-by-case basis.

regarding dojo membership. Dojo must pay all dojo dues and test fees,including dojo fees, kyu and dan test fees, and member dues, as well

All individuals that are officially ranked at any level must become Individual

required fees, dues, or other payments may result in suspension of

shall read and be bound by the guidelines set out in the KNBK Code of Conduct.

New Dojo Membership Application and Guidelines

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Date: _____________ DOJO INFORMATION

Name of Dojo: ____________________________________________

Name of new dojo Instructor: ______________

Name of assistant Instructors ____________________

Dojo Address: ________________________________________

City___________ State_____ Zip code_________

Mailing Address (if different): ______________________________

______________________________

Dojo Phone Number: ______-______________

Fax Number: ______-______________

Website address: ________________________________________________

E-mail: _____________________________________________________

Reason for starting a dojo: ___________________________________________

________________________________________________________________

________________________________________________________________

Please list KNBK dojo you are aware of within 60 miles: __________________

________________________________________________________________

Kokusai Nippon Budo Kai / Jikishin Kai – International

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INSTRUCTOR INFORMATION (If more than one instructor, please copy this page and have all instructors fill out and sign)

Name: _______________________________________________

Home Address: _______________________________________

_______________________________________ City State Zip code

Home Phone: ( ) Work Phone: (___)___________

Cell or other phone: (______)__________________

E-mail address: __________________________________________

Date of birth: _____________________

Profession: _____________________

Current rank: ___________ Date of rank: ___________

Date started in Iaijutsu, Jojutsu or Karate Do: ___________

KNBK / JKI Membership No. (If not a KNBK member, please indicate previous

affiliation): __________________________________________________

Are you Shihan-Dai_____ Shidoin______ or Fukushidoin: ______

List Previous dojo affiliations (include most recent instructor): _______________

________________________________________________________________

List Teaching history: ___________________________________________

________________________________________________________________

List Dates and Locations of last 5 seminars attended: _____________________

________________________________________________________________

________________________________________________________________

I, ___________________, on behalf of the applicant Dojo, hereby agree to accept all regulations, terms and conditions of membership set forth by the KNBK. I understand that future compliance with these conditions is a requirement for continued membership in the KNBK.

_____________________________ Instructor of Dojo Applicant

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SPONSOR INFORMATION

To be filled out by the Sponsor. This form must accompany the application for membership, unless the Instructor of the applying Dojo is a KNBK Shidoin or Shihan-Dai.

Date: _________________

Name of Applicant: ______________________________

Name of Sponsor: ________________________________

Dojo: ___________________________________________

Address: ___________________________________________

Phone Number: ______________________________________

E-mail address: ______________________________________

Title:____________________________________________

Rank:___________________________________________

How long have you known the applicant? ____________________

Please describe your relationship with the applicant: ______________________

________________________________________________________________

________________________________________________________________

Why do you think this applicant is a good candidate to open a dojo? __________

________________________________________________________________

________________________________________________________________

I, _________________________, recommend and support _________________ as a candidate to open a new dojo within the KNBK.

_________________________________ (“Sponsor”)

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FULL NAME: _____________________________________________DATE OF BIRTH: _______________AGE:____

ADDRESS: _______________________________________________________________________________________

PHONE: ___________________DATE STARTED MARTIAL ARTS: _____________TOTAL YEARS____________

PRESENT; RANK: _______ _________________LICENSE / TITLE ______________

OCCUPATION: _________________________________ CELL PHONE: ____________________________________

DOJO: ________________________________________INSTRUCTOR: _____________________________________

DOJO ADDRESS: _________________________________________________________________________________

EMAIL ADRESS: ____________________________CELL PHONE: ______________________________________

MARTIAL ARTS TAUGHT AT THE DOJO: ___________________________________________________________

ORGANIZAIONS YOU ARE A MEMBER OF:__________________________________________________________

PROMOTIONAL LETTER OF INTENT (Nidan and above)Complete this section if you intend to test for a Dan rank promotion during the calendar year you are registering for, a

$50 testing fee must accompany this application section, the fee will be applied towards the certificate total upon passingan examination. If for any reason you fail to complete a successful exam, you may be re-tested after a 6 month period. Ifyou do not complete a successful exam before the next registration, you must submit a new Promotional Letter of Intent.)

I, ___________________________________, am submitting this letter of intent to be considered for advancement during the registration year______. I realize that in order topromote, I must fulfill all my technical and financial requirements.

INTENDED PROMOTIONAL RANK _____________________________________________________

CURRENT RANK AND TITLE: _____________________________________________________________________

DATE OF LAST PROMOTION: _____________________________________________________________________

APPROVED/DISAPPROVED: ______________________________________DATE:___________________________

(REASON IF DISAPROVED): _______________________________________________________________________(If a Letter of Intent is disapproved the application testing fee is returned, a detailed response is given to the applicant in order to better prepare him/her for future advancement consideration.)

The intention of this application process is to prepare the KNBK and its directors to actively and mindfully participate in the technical, educational and organizational needs on behalf of the applicant. Prior to any examination or promotion all considerations are given to the related responsibilities that accompany a new grade or title.

SIGNATURE OF APPLICANT: ______________________________________ DATE:__________________________

I have enclosed a check: _______________________ Please use Credit Card on file:___________________________

MEMBER ID#

Kokusai Nippon Budo Kai / Jikishin Kai – International

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DATE:EMAIL ADDRESS:

NEW STUDENT ENROLLMENTKYU TEST APPLICATION / MENJO REQUEST FORM

KNBK # LAST NAME FIRST NAME

NEW STUDENT START DATE

NEW STUDENT DATE OF BIRTH

ART / IAIJUTSU JOJUTSU KARATE

KYU TEST RANK

KYU TEST DATE

TEST FEE

KNBK DUES CURRENT YEAR

PREVIOUS YEAR DUES

Comments / report-inactive / re-activate student ID ($10)

LINE TOTAL

Use Credit Card on file__yes______no_______

Check enclosed_yes_______no ___________

TOTAL

DOJO: Kokusai Nippon Budo Kai

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Kokusai Nippon Budo Kai / Jikishin Kai Intl. Credit Card Registration Form

PERSONAL INFORMATION:

FIRST NAME: LAST NAME:

DOJO:

CREDIT CARD INFORMATION:

NAME ON CREDIT CARD:

CREDIT CARD NUMBER:

CREDIT CARD EXPIRATION DATE:

CREDIT CARD TYPE:

CREDIT CARD BILLING ADDRESS:

NAME:

STREET:

CITY: STATE: ZIP:

COUNTRY:

PHONE CONTACT: E-MAIL CONTACT:

Signature Date

CREDIT CARD SVC CODE (3 DIGIT):

I, ____________________________________, authorize __________________ to use thiscredit card information in transactions regarding test, dues and KNBK/JKI membershiprelated fees. It is my responsibility to renew the information with ____________________upon epiration of the above referenced credit card.