KA Club Membership Application

KA Club Membership Application
Associated Documents:
Club Administrative Contact

Note: Information regarding this application will be sent to the person below. This contact information may be changed at any time.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Club Information
Club/Dojo Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Members
Website
Social Media Links
Style Association Information

The term Style Association refers to a technical organisation, style, or association that governs the syllabus you study, controls the grading system and provides for examinations and certification.
Does the senior club instructor currently belong to a Style Association that will govern the technical direction of this club?
Specify Style Association
Note: If the answer is "No", then please upload detailed information on your syllabus, grading system, and any other information that will help the technical committee recognise the authenticity of your karate. Skip to the next section.

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Is this Style Association recognised by Karate Canada?
Karate Canada Recognised Style Associations LINK
Note: If the answer is "No", then please upload detailed information on your Style Association including its origin, lineage, syllabus, grading system and any other information that will help the technical committee recognise the authenticity of your karate background.

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Senior Club Instructor

Note: This is the person who is directly responsible for the technical content of the club's curriculum.
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
NCCP #
Upload a Karate/Sport related biography including when you started karate, list all dojos/styles, instructors. Dates of Dan gradings. Certifications and other relevant information.

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Upload Full size colour copies of all Black belt Certificates, Instructor Certificates, Style Association Memberships (if applicable)

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Letter of Reference (right click to download)
Upload Letter of Reference, Download and use above document

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Upload Disclosure Form

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Certification
The above club hereby makes application for membership in the Karate Alberta Association.
The club and its members agree to abide by the Constitution, Bylaws, Rules, Regulations, Codes and Guidelines of the Karate Alberta Association and Karate Canada.

The undersigned hereby certify that the information contained herein is accurate and complete as of the date below. The undersigned agree that any false statements or misrepresentation in this application are grounds for denying or subsequently revoking application and membership in Karate Alberta.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To complete transaction submit Application & E-Transfer Club Application Fee of $100 to Treasurer@karateab.org Memo: Club Application Fee
Privacy Note: The Karate Alberta Association will only use the information in this application for processing your application, maintaining your membership and access to our programs and services and those of Karate Canada. Your information will not be sold or provided to other organizations.
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KA Club Membership Application

Club Administrative Contact

Club Information

Style Association Information

Senior Club Instructor