AKANA Membership Application

American Karate Academies National Association

Charter/Individual Membership Application & Payment Form
Name*

PrefixFirst NameLast Name
Chartered School Membership - $350 (Annually)Yudansha (Black Belt) Membership - $100 (Annually)Lifetime Yudansha (Black Belt) Membership - $350 (One-time payment)Mudansha (Below Black Belt) Membership - $50 (By Kyu Level)
Do you have an existing AKANA verification code?

Yes or NoWhat year did you receive it?Code: (example: OR-007)
Current Membership Status*
Current Teaching Credential Status*
Current Honored Title Status*
Current Rank Status*
Mudansha (Kyu) Membership

This membership includes an 8.5x11 Membership Certificate, the AKANA patch, and all privileges of an AKANA Mudansha (Below Black Belt) Membership. All Mudansha promotions go through their AKANA Chartered School. This membership application is for Kyu-ranked students that do not belong to an AKANA Chartered School but wish to be a part of our AKANA family or who belong to an AKANA Chartered School that prefers AKANA to process their Kyu-ranked Members. The Individual Mudansha application must be approved with the blessing of their teacher through a conversation with an AKANA Board Member. Mudansha Memberships are based on a four-patch system and are due at Beginner, Intermediate, and Advanced Belt Rank. (For example, Beginner Membership is due at 9th Kyu Yellow Belt, Intermediate Membership is due at 6th Kyu Green Belt, and Advanced Membership is due at 3rd Kyu Red Belt). Mudansha Members have a right to purchase additional respective AKANA Beginner, Intermediate, or Advanced Association Patches to wear on their uniform or display on clothing.
Yudansha (Black Belt) Membership

This membership includes an 11x17 Membership Certificate, the AKANA patch, and all privileges of an AKANA Yudansha (Black Belt) Membership. This membership is for Black Belts who belong to an AKANA Chartered School or Individual Black Belts that do not belong to an AKANA Chartered School who wish to be a part of our AKANA family. All Black Belts within an AKANA Chartered School are requested to become AKANA Black Belt Members. Active annual members or lifetime members are eligible for all AKANA Black Belt Certificates, AKANA Certified Teaching Credentials (Sensei or Shihan), and AKANA Honored Titles (Tashi, Renshi, Kyoshi, or Hanshi), endorsed and signed by GM Jerry Piddington for the life of the organization. All promotions go through their AKANA Chartered School unless they are an AKANA Individual Member that does not belong to a chartered school. Only active membership years count toward (time-in) for future promotions, teaching credentials, and certified titles. Black Belt Members have a right to purchase additional AKANA Black Belt Association Patches to wear on their uniform or display on clothing. Please provide jpeg images of Black Belt Members in full uniform that will be used for the website and certificate, and a jpeg image of your last black belt certificate.
School Charter Membership

This membership is for school owners who want to be a part of AKANA. The membership includes an 11x17 Dojo Certificate, an 11x17 Individual Black Belt Certificate, and the AKANA patch, with all privileges of an AKANA School Chartership and Black Belt Membership. All AKANA trademark logos may be used on school advertising, event promotion, and website. There must be special permission in writing to use the logo on merchandise. AKANA Chartered Schools receive all AKANA Mudansha Membership dues and all AKANA Mudansha Kyu-ranked Promotion fees. A template will be provided for AKANA Kyu Memberships and AKANA Kyu Rank Certificates with Hanshi Piddington's signature. The kyu promotion certificates can be customized for your school. AKANA Kyu Membership dues provide AKANA Chartered Schools with additional revenue for their dojos. AKANA Chartered School owners will have access to AKANA Black Belt Certificates, AKANA Certified Teaching Credentials (Sensei or Shihan), and AKANA Honored Titles (Tashi, Renshi, Kyoshi, or Hanshi), endorsed and signed by GM Jerry Piddington. All promotions go through an AKANA Chartered School unless they are an AKANA Individual Member that does not belong to a chartered school. All Black Belts within the AKANA Chartered School are requested to become AKANA Yudansha Members. All AKANA Patches (Association, Tomoe, Kobudo, and Sun & Moon) will be provided at a 50% discount with free shipping. The applicant must have Microsoft Publisher to download and customize provided Kyu-rank certificates. If the school owner does not prefer to provide AKANA Kyu Membership Certificates or AKANA Kyu Promotion Certificates, an option would be to allow AKANA to print and mail the certificates for $5 each with a minimum of 10 certificates per order. Please provide jpeg images with the school owner in full uniform, school logo, style logo, stamps of style, organization, and/or name that will be used for the website and certificates.
Dojo Information

Name of Dojo/School

Mailing Address

CityState / Province

Zip Code
Dojo Phone Number
Dojo Email
example@example.com
Dojo Website
example.com
Individual Information*

Name that will be Printed on Certificate

Mailing Address

CityState / Province

Zip Code
Date of Birth*

Example: 04/13/1959Age
Mobile Phone Number*
Email*
example@example.com
Teaching Information if Applicable

Style Currently TeachingNumber of Years TeachingYear School was Founded
Current Rank*

Prefix (example: Junior)Kyu/Dan (Belt Color)Date PromotedName of Style
Years of (Time-in) Training

Year Started in Martial ArtsNumber of Active Years in Martial Arts
Instructor Information*

Name of InstructorRank/Title of InstructorPhone Number of Instructor
AKANA Accomplishments (if applicable)

Tomoe Warrior StausKobudo Warrior StatusNumber of Sun & Moon Tests
File Upload

Image of Member in Full Uniform (ground up & waist up), Last Black Belt Certificate, School Logo, Chops, Etc.
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Signature

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Payment Process

Once your membership application and payment is processed, certificates and patches will be mailed in 3-5 business days. Thank you for applying.

My Products

Chartered School Membership

Annual membership from the date payment is processed.

$350.00

Individual Black Belt Membership

Annual membership payment from the date payment is processed.

$100.00 Quantity

Lifetime Individual Black Belt Membership

One-time payment for the life of the organization.

$350.00 Quantity

Kyu-rank Membership

For students who are not affiliated with an AKANA Chartered School. Memberships are issued by Kyu-rank levels.

$50.00

Additional Rank Patches

$10.00

	Quantity	Price
Beginner		$10.00
Intermediate		$10.00
Advanced		$10.00
Black Belt		$10.00

Item subtotal:$0.00

Additional Instructor Patches

$20.00

	Quantity	Price
Sensei		$10.00
Shihan		$10.00
School Charter		$10.00
Head of Style		$10.00

Item subtotal:$0.00

Optional Certificate Printing

For AKANA Chartered School Members who prefer AKANA to print their Mudansha membership certificates. Must purchase at least 10 certificates. Type information for certificates in the text box below.

$50.00 Quantity
Item subtotal:$0.00

Total

$0.00

Certificate Information
Type a list of all membership levels, name printed on the certificate, date joined, and rank with the color of belt and Kyu or Dan level. Example: Beginner Level: John Smith, 04/12/2022, Jr. Yellow Belt (9th Kyu) (next line), Advanced Level: Rick Jones, 04/12/2022, Red Belt (3rd Kyu). If preferred, type a separate Word Document and email it to hombudojo@akana.org.

Payment Methods

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American Karate Academies National Association

Mudansha (Kyu) Membership

Yudansha (Black Belt) Membership

School Charter Membership

Payment Process