International Uechi-ryu Karate Federation
POB 1403
Mount Dora, FL 32756
Tel: 352-552-0204 Fax: 352-383-6227

Application form: for Dojo and Individual Membership in Federation

This form to be faxed or mailed.

Members receive IUKF uniform crest, Passport, password to private "Learning Center" website, monthly NewsLetters, instruction tips, reduced rates at IUKF activities, book, video and product discounts. Dojo members receive free Ad in the Dojo Listings. PLUS.. A free copy of The Black Belt Test Guide, 2nd edition, e-Book.

Affiliation:
( ) Uechi-ryu ( ) Shoheiryu ( ) Other _____________________________
Membership: ( ) Student or Teacher Membership . . . . $50/ 1st/yr.. $35 thereafter
( ) Lifetime Members(All Categories). . . . . . .. . . . . . . .$750

Applicant:____________________________________Male________ Female___________

Birthdate: Mo______________Day_______ Year________

Address: ___________________________________________________________________

City: ______________________ State___________________Postal Code_____________

Country:________________________________ Phone (______)_____________________

Dojo:_______________________ e-Mail:___________________@_______________._______

Affiliation:___________________________________________________________________

Teacher history: 1st_____________________________ 2nd_________________________
3rd_______________________________Other______________________________________

Styles Studied:_______________________________________________________________

Ranks earned/style: _________________________________________________________

Association awarding ranks:___________________________________________________

Organizational Affiliations________________________________________________________

All Individual Memberships in the IUKF are issued on a Calendar Year basis (except Lifetime Membership) First year membership is $50, thereafter the membership fee is $35. (New members receive a permanent IUKF I.D. number, which can be used for discounts on all Uechi-ryu.com store purchases, including Summer and Winter Fest.) New members also receive a beautiful membership certificate, IUKF PassBook and the official IUKF uniform crest & e-Book. By applying for membership, I hereby fully and unconditionally release the IUKF , its Officers and Directors, Certified Instructors and Member dojo from any and all claims for any and all injuries, accidents or losses that I may receive while practicing the martial arts sanctioned by the IUKF.

Signature of Applicant_______________________________Date___________________

Using PayPal? Send payment to: IUKFMEMBER@aol.com
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Date Approved by IUKF______________________ IUKF Membership number:_____________