ACADEMY

(ASF) (Regd.)

OF

SPORTS

&

FITNESS

Affiliated
to,
American Japan Karate Association International India (AJKAII)
AJKAII Member of American Japan Karate Association International (AJKAI)
(Recognized by Govt. of India, Sports Ministry)
President & Chief Instructor: Shihan. Anil B. Garodia, 6TH Dan AJKAI, 6TH Dan AIKF
E-mail: karateasf@gmail.com
Mob: 9821975510 / 80979 00446
Chandra-Ban, Geeta Nagar7-A, Near Flyover Bridge, Bhayandar (E)

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REQUEST FOR REGISTRATION

Date:

Photo

To,
The Chief Instructor,
ASF
Sir,
Please enrol Me / My, Son / My Daughter as a member of your
Academy. I have read the Rules & Regulation of your Academy & agree
to abide by them.
I hereby accept full responsibility & consequences injury occur to Me /
Him / Her at a time of Tournament / Training.
___________________________
_______________________
Applicant Signature
Signature

Parents

APPLICANTS PERSONAL DETAILS

Name:
_________________________________________________________________________________
Residential Address:
___________________________________________________________________
________________________________________________________________________________________
Office / School Address:
________________________________________________________________
_____________________________________________________________ Pin Code:
_________________
Tel: ___________________ Mob: __________________________
_________________________

E-mail:

Gender: _________________ Date of Birth: __________________ Occupation:

__________________
Education: ___________________ Height: ________ Weight: _________ Native Place:
___________
Instructor Incharge:
____________________________________________________________________

FOR OFFICE USE

Branch: _________________________ District: _____________________ Mem. No:
______________
State: _____________________ I.D.Card No. __________ INSTRUCTOR:
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