Please fill in the form below to apply for and purchase a UKSKO licence. Personal information Title Mr Mrs Miss Ms Master First name Surname Date of birth Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 Contact information Email address Re-enter email address Phone Address City/County Postcode Country Other information Health concerns Heart problems Haemophilia Diabetes Epilepsy Asthma Migraine Nervous Disorders Other health concerns Do you have any criminal convictions? Yes No Select membership type 10th Kyu (white belt) to 2nd Kyu (brown/white stripe belt) Junior (under 16) – £38.00 Adult – £55.00 1st Kyu (brown belt) Junior (under 16) – £55.00 Adult – £65.00 Dan grades (black belts) Junior (under 16) – £55.00 Adult – £65.00 Do you already have a UKSKO licence/grading book? Yes No Please select your current belt colour White Belt (beginner) 10th Kyu 9th Kyu 8th Kyu 7th Kyu 6th Kyu 5th Kyu 4th Kyu 3rd Kyu 2nd Kyu 1st Kyu 1st Dan (Shodan) 2nd Dan (Nidan) Club member You must be a member of a UKSKO club to join. Please select your club from the list below. Aldershot, Aldershot Ashford, Bedfont Coummunity Centre, Ashford Bedfont, Bedfont Sports Club, Feltham Bisley C of E primary school, Bisley C of E primary school, Woking BSKA, Bu’sen Martial Arts and Sports Trust, Twickenham Bu’sen Martial Arts School, Twickenham Chobham Karate Club, Chobham Community Centre, Chobham Cleves School Karate Club, Dance Studio, Weybridge Cranford Primary School, Cranford Primary School, Cranford Daventry Karate Club, Daventry Methodist Church, Daventry Ellingham Primary School, After School Club, Chessington Feltham, Feltham Community Centre, Feltham Fenny Compton Karate Club, Fenny Compton Village hall, Fenny Compton Guildford Karate Club, Guildford Spectrum, Guildford Hampton Karate Club, Hampton Community Centre, Hamton Hampton Sports Centre Karate Club, Dance Studio, Hampton Hindhead Karate Club, St Albans Church Hall, Hindhead Isleworth Karate Club, British Legion, Isleworth Isleworth Town Primary School Karate Club, Isleworth Town Primary School, London Kensington Karate Club, St Philips Church, London Kew Riverside School Karate Club, School Hall, London Kineton Karate Club, Kineton Village Hall, Warwick Lime Tree Primary School, After School Club, Surbiton LT, The Gunnersbury Triangle Club, London Mickleham Karate Club, Mickleham Village Hall, Dorking MJN Hayes Karate Club, ST. Marys church hall, Hayes MJN Hillingdon Karate Club, All Staints Church Hall, Hillingdon MJN Northwood Karate Club, Northwood Methodist Church Hall (youth hall), Northwood MJN Pinner Karate Club, Pinner Village Hall, Pinner MJN ST JOHN FISHER SCHOOL, New Haw Karate Club, All Saints Church Hall, New Haw Newland House School, Newland House School, Twickenham NKA, Orchard Primary School, Orchard Primary School, Hounslow Orleans Park Karate Club, Orleans Park Sports Centre, Twickenham Reach Academy , Sports Hall, Feltham Royal Kent karate club, The Royal Kent school, Oxshott Shene Sports Centre Karate Club, Sports Hall, London Shepperton, The Old School Building, Shepperton Shoden - Chessington Sports Centre, Chessington Sports Centre,, Chessington Shoden - Coombe Hill Karate Club, Coombe Hill Junior School, Kingston upon Thames Shoden - Ellingham, Shoden - Grand Avenue, Grand Avenue Primary School , Surbiton Shoden - Southborough High School, Southborough High School , Tolworth Shoden - St Matthews, St Mathews Primary School, Surbiton Shoden - Thames Ditton, Thames Ditton Infant School, Thames Ditton St Andrews Prep School, Horsell St Barnabas School Karate Club, School Hall, London St Mary Abbots School karate Club, School Hall, London St Mary Magdalen’s Karate Club, St Mary Magdalen’s School, London St Paul's C of E Primary School, St Paul's C of E Primary School, Addlestone Teddington Sport Centre Karate Club, The Studio, London The Mall, The Mall School, Twickenham Tony's Karate Coaching (TKC), Holy Trinity Church Hall, Twickenham Twickenham Prep School Karate Club, Hampton Unicorn School Karate Club, School Hall, London Whitehouse, Whitehouse Community Centre, Hampton Whitton Karate Club, Whitton Sports Centre, Whitton Whitton Murry Park Karate Club, Murry Park Hall, Whitton Yawara Martial Arts Lightwater, Lightwater Leisure Centre, Lightwater Yawara Martial Arts Wandsworth, Wandle Recreation Centre, Wandsworth Yawara Martial Arts Woking, Woking Leisure Centre, Woking
