Individual AKANA Membership Application

American Karate Academies National Association

Individual Membership Application & Payment Form
Name*

PrefixFirst NameLast Name
Mudansha (Kyu-rank) Below Black Belt Membership -$50 (By Rank)Yudansha (Dan-rank) Black Belt Membership - $100 (Annually)Lifetime Yudansha (Dan-rank) Black Belt Membership - $350 (One-time payment)
Do you have an existing AKANA verification number?

Yes or NoState verified in (example: OR)Number (example: OR-007)
Current Membership Status*
Current Teaching Credential Status*
Current Honored Title Status*
Current Rank Status*
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. 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 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 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

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), School Logo, Chops, Etc.
Cancelof
Signature

Clear
Approval Process

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