AKANA Membership Payment Form

American Karate Academies National Association

Renewal Payment Form
Name:*
Will be printed on your certificate
Dojo:*
Chartered dojo you are applying under
Style:*
Will be printed on your certificate
Title:*
Age:*
Time-in Training*
Years
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
AKANA Verification Code
example: NC-001-002-YM (located on certificate)
T-Shirt Size*
File Upload

Optional: Updated picture in uniform with AKANA patch (full body)
Cancelof
If applying for multiple renewals, please list their name, rank, t-shirt size, and AKANA verification number in the box below.

My Products*

AKANA School Charter Renewal

Paid annually from the date payment is processed. Includes an individual membership card recognizing rank and style with the respective patch.

$350.00

AKANA Individual Black Belt Renewal

Paid annually from the date payment is processed. Includes an individual membership card recognizing rank and style with the respective patch.

$100.00 Quantity
Item subtotal:$0.00

AKANA Mudansha Kyu-rank Membership

Paid annually from the date payment is processed. Includes an 8.5x11 membership certificate recognizing rank with the respective patch. Three levels: Beginner (10th-7th Kyu), Intermediate (6th-4th Kyu), Advanced (3rd-1st Kyu).

$50.00

	Quantity
Beginner Membership
Intermediate Membership
Advanced Membership

Item subtotal:$0.00

Total

$0.00

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American Karate Academies National Association