Combat Academy UK
Annual Membership Renewal. Details of person attending classes please.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Town
County
Postcode
Date of birth
*
-
Day
-
Month
Year
Phone Number
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Email address (for newsletter and correspondence)
Are you a new member or a renewal?
*
I am a new member applying for the first time.
I am renewing my annual membership.
Club
*
Date of expiry of current club licence (On back page, your licence will be dated one year from this date by your club instructor only) If you are a new member put todays date
*
-
Day
-
Month
Year
Date
Which Class do you attend?
*
Please Select
Ian Gauldie Windsor
Ian Gauldie Maidenhead
Ian Gauldie Bracknell
Dave Lancaster Widmer End
Andy Holmes Wokingham
Cliff Randall Chertsey
Alun Freeman Windsor
Chris Adams Isle of Man
Andrew Furnell Bracknell
Grade (if any)
Payment
*
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Adult Annual Membership Fee (13 years and over)
£54.50
£
54.50
Junior Annual Membership Fee (12 years and under)
£49.50
£
49.50
Details of any medical information
i.e recent operations, serious illness more serious injury. Please note that you may be required to provide letter of approval from your doctor or medical specialist.
C.M.A.A. MEMBERS ARE AUTOMATICALLY COVERED BY GROUP MEMBER TO MEMBER AND PUBLIC LIABILITY INSURANCE PROVIDED YOUR LICENCE IS IN DATE. This is not a Personal Injury Policy. It provides cover in the event that you should damage property or injure another student during training. It will not pay benefits should you be off work for a length of time as a result of an injury sustained during training. For further information contact the C. M. A. A - www.cmaauk.com I the trainee indemnify the club in respect of any injury caused to another member or against losses caused to the club by any act of mine or default. I the trainee understand that the training and practice of the martial arts can be dangerous and I agree personally to bear all losses caused by injury whilst engaged in it. NOTE: You are reminded of the C.M.A.A bylaws, which state that the annual renewal of the licence is your responsibility and that out of date applications will be backdated. I agree whilst I am a member of the above named club within the Cobra Martial Arts Association that this form will be signed every year and will be acceptable for further licensing applications, which will be shown in my licence book. I also understand that if I allow my licence to remain out of date for any significant time, I will not be permitted to grade. Please note that your club licence will be renewed for 1 year from its current date of expiry and NOT from the date of renewal.
*
Parent if under 18 years old.
Date
*
-
Day
-
Month
Year
Date
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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