CHARLOTTETOWN & CENTRAL QUEENS
CHITO-RYU KARATE CLUBS

MEMBERSHIP APPLICATION

(1) Complete the sections below,  (2) Print the page, and (3) Submit with your membership dues.

 

Date:
Name:
Age (years):
 
Male Female
Mailing Address 1:
2:
3:
Phone:
Medical Condition /allergies 1:

2:

Youth (6-15 years)

 

Session joining:

Fall (Sep-Dec) Winter (Jan-May)

Signature  
Parent or Guardian  
(if under 18):

 
(1) Complete the sections above,  (2) Print the page, and (3) Submit with your membership dues.
 
To see COSTS for membership, check the DOJOs page (Click)

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