Membership No (Leave it blank if you don't know it.)

Forename (CAPITAL)*

Surname (CAPITAL)*

D.O.B*

Gender*
—Please choose an option—FemaleMale
Nationality*

Club*
—Please choose an option—HarrowHayesHayes Ladies ClassHendon/EdgwareWindsorHestonUxbridge
Current Grade*
—Please choose an option—10th Kup, White9th Kup, High White8th7th6th5th4th3rd2nd1st
Applying for*
—Please choose an option—10th Kup, White9th Kup, High White8th7th6th5th4th3rd2nd1st
Fees*
—Please choose an option—£40, High White£45, Yellow£50, High Yellow
Kukkiwon No (For Black Belts ONLY)

Kukkiwon Issue Date (For Black Belts ONLY)

Date of Promotion Test

Your Email (required)

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