American Karate Academies National Association
Individual Membership Application & Payment Form
Name
*
None
Sensei
Tashi
Renshi
Shihan
Kyoshi
Hanshi
Other
Prefix
First Name
Last Name
Check the membership you are applying for?
Mudansha (Kyu-rank) Below Black Belt Membership -$50 (By Rank)
Yudansha (Dan-rank) Black Belt Membership - $100 (Annually)
Do you have an existing AKANA verification number?
No
Yes
Yes or No
State verified in (example: OR)
Number (example: OR-007)
Current Membership Status
*
Please Select
Non-member
School Charter Member
Yudansha Black Belt Member
Mudansha Kyu-rank Member
Lifetime Member
Current Teaching Credential Status
*
Please Select
No Teaching Credential
Sensei Teaching Credential (2nd Dan & up)
Shihan Teaching Credential (6th Dan & up)
Current Honored Title Status
*
Please Select
No Honored Title
Tashi
Renshi
Kyoshi
Hanshi
Current Rank Status
*
Please Select
Beginner Kyu-rank
Intermediate Kyu-rank
Advance Kyu-rank
Jr. Black Belt
Shodan (1st Dan)
Nidan (2nd Dan)
Sandan (3rd Dan)
Yondan (4th Dan)
Godan (5th Dan)
Rokudan (6th Dan)
Nanadan (7th Dan)
Hachidan (8th Dan)
Kudan (9th Dan)
Judan (10th Dan)
Yudansha (Black Belt) Membership
This membership includes an 11x17 Membership Certificate, an 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. If an Individual Black Belt belongs to a school that is not an AKANA Chartered School, the blessing of the school owner is required through a conversation with an AKANA Board Member. Active annual 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. 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 with a clean background.
Mudansha (Kyu) Membership
This membership includes an 8.5x11 Membership Certificate, an 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.
Dojo Information
Name of Dojo/School
Mailing Address
City
State / 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
City
State / Province
Zip Code
Date of Birth
*
Example: 04/13/1959
Age
Mobile Phone Number
*
Email
*
example@example.com
Teaching Information if Applicable
Style Currently Teaching
Number of Years Teaching
Year School was Founded
Current Rank
*
Prefix (example: Junior)
Kyu/Dan (Belt Color)
Date Promoted
Name of Style
Years of (Time-in) Training
Year Started in Martial Arts
Number of Active Years in Martial Arts
Instructor Information
*
Name of Instructor
Rank/Title of Instructor
Phone Number of Instructor
AKANA Accomplishments (if applicable)
None
Bronze
Silver
Silver Diamond
Gold
Gold Diamond
Pinnacle
Tomoe Warrior Staus
Kobudo Warrior Status
Number of Sun & Moon Tests
File Upload
Browse Files
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Image of Member in Full Uniform (ground up & waist up), School Logo, Chops, Etc.
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Signature
Approval Process
Once the membership is processed, certificates and patches will be mailed in 3-5 business days. Thank you for applying.
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Black Belt Membership
Annual membership from the date payment is processed.
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Kyu-rank Membership
For students who are not affiliated with an AKANA Chartered School. Memberships are issued by Kyu-rank levels.
$
50.00
Beginner 10th Kyu
Intermediate 6th Kyu
Advanced 3rd Kyu
Additional Patches
$
10.00
Quantity
Price
Beginner
1
2
3
4
5
6
7
8
9
10
$
10.00
Intermediate
1
2
3
4
5
6
7
8
9
10
$
10.00
Advanced
1
2
3
4
5
6
7
8
9
10
$
10.00
Black Belt
1
2
3
4
5
6
7
8
9
10
$
10.00
Payment Methods
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the form.
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