Hombu Dojo Karate International Ireland Registration Name* First Last DOB* Address* Street Address Address Line 2 City ZIP / Postal Code Occupation Phone* Grade* 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 Dan Email* Enter Email Confirm Email Are you registering a new licence?* Yes No, I'm renewing my licence Previous Licence Expiry Date Day12345678910111213141516171819202122232425262728293031 Month123456789101112 Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Only for new Licence applications (Only for new applications) Have you ever practiced a martial art? Yes No If yes, please give brief details including affiliation, grade obtained & examiner Have you ever been convicted of a crime of violence? Yes No If yes, please give brief details Do you suffer a medical condition that could affect or prevent you practicing Karate? Yes No If yes, please give details including any regular medication. Upload Your Photo I accept that training in karate could involve the risk of injury’* I accept I dont accept I also agree & acknowledge that my photograph may be taken during seminars and may be used by the Hombu Dojo Karate International on Social Media or Brochures & related materials.* I agree I do Not agree We will never identify you without your prior agreement. Licence Type Hombu Dojo New Licence / Renewal New LicenceRenewalReplacement Licence Arrears no arrearsone yeartwo yearsthree years If your licence has expired for more than one year CAPTCHA Total 0,00 € Credit Card* American Express Discover MasterCard Visa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Phone This field is for validation purposes and should be left unchanged.