JKI Dojo Membership Application

Jikishin-Kai International

Dojo Membership Application
Dojo Name:*
Name of Applicant Dojo
Dojo Street Address:*

Street Address (Actual Location)

Street Address Line 2

CityState / Province / County / Prefecture / Etc.

Postal / Zip CodeCountry
Dojo Mailing Address (if different):

Mailing Address

Mailing Address Line 2

CityState / Province / County / Prefecture / Etc.

Postal / Zip CodeCountry
Dojo Phone Number:*

Country CodeArea CodePhone Number
Alternate Phone Number (if any):

Country CodeArea CodePhone Number
Dojo Email Address:*
example@example.com
Website URL of the Dojo:
(FORMAT: https://mydojo.com)
Facebook Account of Dojo:
(Enter or copy-paste URL above)
Twitter Account of Dojo:
(Enter or copy-paste URL above)
Other Social Media Account of Dojo:
(Enter or copy-paste URL above)
Forms of Budo Currently Taught / Practiced:*

Karate-doRyukyu / Okinawa KobudoIaido / Iaijutsu / Batto-ho / Batto-doJodo / JojutsuKenjutsu (Koryu)Kendo (Sport)AikidoJudoJujutsu / Aiki-jujutsuOther (list below)
Other Forms of Budo Currently Practiced:
List here, separated by commas
Forms of JKI Budo Your Dojo Intends to Teach:*

Shimabukuro-Ha Shito-Ryu Karate-doOkinawa Kobujutsu (bo, sai, etc.)Muso Jikiden Eishin-Ryu IaijutsuShindo Muso-Ryu JojutsuOno-Ha Itto-Ryu KenjutsuOther (specify below)
Other Forms of JKI Budo to be Taught:
List here, separated by commas
Was Your Dojo or its Dojo-Cho a Member of the Original (1993 to 2012) JKI?*

YesNo
Current Number of Students Regularly Training at Your Dojo:*

1 to 1011 to 2526 to 5051 to 100More than 100
Name of Dojo-Cho (Owner / Manager / Chief Instructor / Leader): *

Prefix (Dr., Rev., etc.)First NameMiddle Name or InitialLast NameSuffix (Sr., Jr., PhD., etc.)
Title of Dojo-Cho:*
(Sensei, Shihan, Kaicho, etc.)
Personal Phone Number of Dojo-Cho:*

Country CodeArea CodePhone Number
Personal Email Address of Dojo-Cho:*
example@example.com
Gender of Dojo-Cho:*

MaleFemalePrefer not to answer
NOTE: The Dojo-Cho must also submit an individual Membership Information Form upon acceptance of the dojo for JKI membership.

Dojo Membership Listing:Upon acceptance of this application, the Jikishin-Kai International will list the following information about your dojo on our website (www.jikishin-kai.org):

• Name of the Dojo
• Street Address of Dojo
• Phone Number of the Dojo
• Email Address of the Dojo
• Name of the Dojo-Cho
• Title of the Dojo-Cho
• Website URL of the Dojo
• Social Media sites of the Dojo
• Forms of JKI Budo Taught
• Forms of non-JKI Budo Taught

If there is any of the above information you DO NOT wanted listed, please check the corresponding boxes below:
DO NOT List the Following Information on the JKI Website

Do not list our Dojo at allDo not list our Dojo Street AddressDo not list our Dojo Phone NumberDo not list our Dojo Email AddressDo not list the Name & Title of our Dojo-ChoDo not list the Website URL of our DojoDo not list the Social Media Site of our DojoDo not list the Forms of JKI Budo TaughtDo not list the Forms of non-JKI Budo TaughtList our Dojo MAILING Address INSTEAD of its Street Address
Dojo Membership Dues*
prevnext( X )
Annual Dojo MembershipDojo membership for the full calendar year 2023
$75.00

Charter Membership DiscountCharter membership discount if paid in full by 31 March 2023
$-15.00

Total

$0.00
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Jikishin-Kai International