Membership Application
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SEISHI-RYU KARATE KOBUDO FEDERATION
105 West Chew Avenue Philadelphia PA. 19120 USA
Ph: (267) 000-0000
MEMBERSHIP AND RANK CERTIFICATE
Blacks Belts $75.00-Under Belts $50.00 and $7.00 Shipping



Dojo/Organization:_______________________________________________________________

Sensei:_________________________________________Rank:___________________________

Address:________________________________________________________________________

Zip:___________________

Last Date Promoted:______________

Name on Certificate:_________________________________________

Present Rank:________________________________________

Promotion Date:_____________ SKKF No# ________________

Kobudo Rank:____________________ No# _________________

Karate Rank:____________________ No# _________________



Complete this form CAREFULLY and LEGIBLY. Mail with a U.S. Money Order, for the full amount of Membership and Rank Certificate which is combined into one to the above address in the name of Tyrone Wiggins . Do not send cash. Request will be handled promptly upon arrival. For individuals to receive a promotional certificate from the SKKF, they must be an active member of the federation. please note, that each time you receive a rank certificate, it's the same (combined).



Date:___________________ Total Fees:______________