Australian Judo Union Shop - Judo For Self Defence 2019

Please tick the applicable Declaration Statements. . . .
I hereby agree to abide by the rules of the Australian Judo Union Inc.
I understand and agree that payment of this application fee does not constitute automatic acceptance of this membership application.
I declare that I am not subject to investigation or any disciplinary action by any other judo or martial arts organisation.
I acknowledge that further information about myself may be required by the Australian Judo Union about my judo history and background and agree to provide that information upon request.
I am an Australian Citizen
I am a permanent resident of Australia.
I am NOT an Australian Citizen or Permanent Resident of Australia.

Medical & Disability Declaration
I certify that I do not have a medical condition or disability which may prevent me from participating in normal judo activities.
I declare that I do have a medical condition or disability which will impact on me participating on normal judo activities and have provided a summary outline below.
I certify that all the information provided by me on this membership application form is true and correct.

What is your rank?

What is your current residential address date of birth and medicare number? Please also provide any medical or disability history you may have.

First name . . .

Last name . . .

Phone . . .

Email . . .

D.o.B. . . .

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Gender . . .

Primary Club . . .