Licence Registrations 1 HDKI GB Licence Registrations and Renewals Name* First Last Please select*MaleFemaleTransgenderDOB* Address* Street Address Address Line 2 City ZIP / Postal Code Phone*Email* Enter Email Confirm Email OccupationEthnicity*Please selectAsian/Asian British - IndianAsian/Asian British - PakistaniAsian/Asian British - BangladeshiAsian/Asian British - ChineseAsian/Asian British - Any other background (please describe below)Black/African/Black BritishBlack/Caribbean/Black BritishBlack - Any other background (please describe below)Mixed - White and Black CaribbeanMixed - White and Black AfricanMixed - White and AsianMixed - any other multiple ethnic backgroundWhite - English/Welsh/Scottish/Northern Irish/BritishWhite - IrishWhite - Gypsy or Irish TravellerWhite - Any other White ethnic background (please describe below)Any Other Ethnic Group (please describe below)Choose one option that best describes your ethnic group or background. If required please describe that further in the box below.please describeGrade*Beginner - White BeltWhite - 1 stripe - 12th kyuWhite - 2 stripes - 11th kyuWhite - 3 stripes - 10th kyuOrange with white stripe - kari 9th kyuOrange - 9th kyuRed with white stripe - kari 8th kyuRed - 8th kyuYellow with white stripe - kari 7th kyuYellow - 7th KyuGreen with white stripe - kari 6th kyuGreen - 6th kyuPurple - 5th kyuPurple with white stripe - 4th kyuBrown - 3rd kyuBrown - 2nd kyuBrown - 1st kyuBlack - 1st danBlack - 2nd danBlack - 3rd danBlack - 4th danBlack - 5th danBlack - 6th danBlack - 7th danBlack - 8th danPrevious Licence Expiry DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is this a New Registration or a Renewal?*- please select -New RegistrationI'm renewing my licenceOnly for new Licence applicationsHave you ever practiced a martial art? yes no If yes, please give brief details including affiliation, grade obtained & examinerHave you ever been convicted of a crime of violence? yes no If yes, please give brief details.Upload your photoAccepted file types: jpg, gif, png, pdf.Do you have a medical condition or disability that could affect or prevent you practicing Karate? yes no If yes, please give brief details.I accept that training in karate could involve the risk of injury* I don't accept I accept Select a Club*DEVON - PLYMOUTH KARATE-DODEVON - HDKI South WestGLOUCESTERSHIRE - CHELTENHAM KARATE CLUBGLOUCESTERSHIRE - SHOTOKAN TORA WINCHCOMBEHAMPSHIRE - BLACKWATER VALLEY SHOTOKAN KARATEHAMPSHIRE - RIDGEWAY SHOTOKAN KARATE CLUBKENT - CANTERBURY KARATE ACADEMYLANCASTER - HADASHI SENSHI DO SKCNOTTINGHAMSHIRE, SHOGAI KARATE, SOUTH LEVERTONWEST MIDLANDS - BLACK COUNTRY SHOTOKAN KARATELANCASTER, HADASHI SENSHI DO - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalCLEETHORPES SHOTOKAN KARATE CLUBPlease select if you require a New Licence or RenewalNew LicenceRenewalPLYMOUTH KARATE DO - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalSKC Cherry Hinton Dojo - New Licence / RenewalPlease select if you require a New Licence or RenewalNew LicenceRenewalLEEDS SHOTOKAN ELITE - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalCHIKARA KARATE - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalBlack Country Shotokan Karate - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalSEISHIN SKC - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalWEST BRIDGFORD,NOTTINGHAM - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalLADYBAY DOJO - NOTTINGHAM - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalBASFORD - NOTTINGHAM - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalRIDGEWAY SHOTOKAN KARATE CLUB - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalShin-Gi-Tai - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalBLACKWATER VALLEY SHOTOKAN KARATE - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalKYOKAI SHOTOKAN KARATE, CARDIFF - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalCHELTENHAM KARATE CLUB - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalShotokan Tora Winchcombe - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalNOTTINGHAMSHIRE, SHOGAI KARATE - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalCANTERBURY KARATE ACADEMY - New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalDevon - HDKI South West New Licence / RenewalPlease select if you require a New Licence or Renewalplease selectNew LicenceRenewalCAPTCHAHDKI South WestPlease see your Club Sensei for registration options.Total £ 0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name
