WEST AUSTRALIAN KENDO RENMEI Incorporated

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Online EFT Payments – BSB 036082 Account # 294691 - Please e-mail payment confirmation to treasurer@wakr.asn.au

Details

Type:

AKR#:

First name:

Last name:

Date of birth:

Email:

Mobile:

Telephone:

Club:

Gender:

WWC Expiry:

NCAS Level:

First Aid Level:

First Aid Expiry:

Arts

Iaido

Iaido grade:

Iaido grade date:

Iaido grade location:

Jodo

Jodo grade:

Jodo grade date:

Jodo grade location:

Kendo

Kendo grade:

Kendo grade date:

Kendo grade location:

Address

Street:

Suburb:

City:

State:

Post Code:

Country:

Payment and declaration

Fees:

Payment method:

EFTChequeCash

Payment date:

Payment reference:

I agree that WEST AUSTRALIAN KENDO RENMEI (INC) will not be held responsible for loss or injury sustained by me.

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Online EFT Payments – BSB 036082 Account # 294691 - Please e-mail payment confirmation to treasurer@wakr.asn.au