FSKL Individual Registration Form
First Name
Last Name
Years of Training
d
Birtdate
Sex
Rank
Style
Other Style
01
02
03
04
05
06
07
08
09
10
11
12
/
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Male
Female
10th Kyu
9th Kyu
8th Kyu
7th Kyu
6th Kyu
5th Kyu
4th Kyu
3rd Kyu
2nd Kyu
1st Kyu
1st Dan
2nd Dan
3rd Dan
4th Dan
5th Dan
6th Dan
7th Dan
8th Dan
Chito-Ryu
Goju-Ryu
Ishin-Ryu
Joshinmon
Koeikan
Kyokushin Kai
Okinawa Kenpo
Renshikan
Ryobukai
Ryuei-Ryu
Shintokuakai
Shito-Kai
Shito-Ryu
Shotokan
Uechi-Ryu
Wado-Ryu
Yoshukai
Other
Address
City
State
Zip
a
Phone
(
)
-
a
Email
d
-
Dojo Information
3
Dojo Name
d
Instructor First Name
Last Name
Title
Shihan
Sensei
Senpai
Other
2
Dojo Address
a
City
State
Zip
3
Dojo Phone
Dojo Email
(
)
-
1
Dojo Fax
Dojo Website
(
)
-
d
Questionnaire
Yes
No
1. Are you familiar with the new World Karate Federation sparring rules?
2. Have you competed at a tournament using the new WKF rules?
3. Are you interested in becoming a FSKL member?
4. Do you have a certified referee license with the USANKF?
5. Are you interested in certifying as a referee with the FSKL?
6. Are you interested in competing in FSKL sponsored events?
7. Would you like to be added to the FSKL mailing list to receive event information?
Questions/Comments
Please list any comments or questions you may have. Please let us know if you would like a FSKL director to contact you with more specific information about the Florida Sport Karate League.
Comments/Questions
Please fill out the form above, print it, then mail it to
The Florida Sport Karate League
2531 NW 91st Drive
Gainesville, FL 32606