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:
*
Please Select
None
Senpai
Sensei
Tashi
Renshi
Shihan
Kyoshi
Hanshi
Sifu
O'Sensei
O'Shihan
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
*
Please Select
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
File Upload
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Optional: Updated picture in uniform with AKANA patch (full body)
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If applying for multiple renewals, please list their name, rank, t-shirt size, and AKANA verification number in the box below.
My Products
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AKANA School Charter Renewal
Paid annually from the date payment is processed. Includes a 5X7 School Charter renewal certificate. Also includes an individual membership renewal with respective patch.
$
350.00
AKANA Individual Black Belt Renewal
Paid annually from the date payment is processed. Includes a 5x7 Individual Black Belt renewal certificate recognizing rank with the respective patch.
$
100.00
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AKANA Mudansha Kyu-rank Membership
Paid annually from the date payment is processed. For students who are not a member of an AKANA Chartered School. 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
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Intermediate Membership
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Advanced Membership
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Item subtotal:
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