WORLD DAN COMMITEE - APPLICATION FORM

Hereby I hereby request non-contributory admission and/or membership in the:

 - International Board of World Dan Comittee -

First name:.....................................................................................................................................

Surname:.......................................................................................................................................

Address:........................................ ...............................................................................................

……………….........................................................................  Postal code:....................................

Country:........................................................................................D.O.B:.......................................

Tel.:..........................................................................Fax:..............................................................

Email:............................................................................................................................................

Highest Dan Grade:..................... Style:..........................................................................................

Further Grades:..............................................................................................................................

Dojo/Association Name:......... ........................................................................................................

Dojo Instructor: ..............................................................................................................................

Master:..........................................................................................................................................

I enclose proof of my Dan/Degree and/or Coach Diploma or comparable degree.

I understand that admission/membership is confirmed with the forwarding of my photograph and letter. 

If desired (no obligation) you can do also request an official Committee Photo Certificate.    

I hereby request the Committee Photo Certificate at the certificate fee of Euro or $ 35

All admission fees must be paid before membership is issued by either:

O Cheque

O Pay Pal

O Cash (by insured letter)

O Bank Transfer  (see below)     Bank name: Deutsche Bank Muenchen

BIC: DEUTDEDBMUC      IBAN DE12 7007 0024 0452 2132 01      Holder: A.D.D.I.
( A copy of the transfer voucher will be included with your membership application ) 

With my signature I confirm the correctness of my data.
 

Date:................................................Signature:...............................................................................

Send to: A.D.D.I. / WDC, Postfach 080120, 10001 Berlin -Germany, Fax: ++49 30 / 20659-200