HUNGARIAN BUDOKAI INTERNATIONAL
& AMERICAN BUDOKAI INTERNATIONAL (optional)

P.O. Box 50774 * Sarasota, FL 34232 * 011.1.941.378.3760

New Membership / Renewal / Promotion Application

PLEASE PRINT CLEARLY

DATE:   ______/_______/_______ 
 

NAME: ________________________________________________

ADDRESS: _____________________________________________________________
 

CITY: _____________________________________ STATE: _____________________

ZIP: _____________________ COUNTRY: ____________________________________

PHONE: __________________________________ DOB: _____ / ______ / _________

AGE: _____ SEX: _____ EMAIL: ____________________________________________

SCHOOL NAME: _________________________________________________________

SCHOOL ADDRESS: ______________________________________________________

_______________________________________________________________________

INSTRUCTOR NAME: _____________________________________________________

NAME OF STYLE: _________________________________-_______________________

MEMBER OF OTHER ORGANIZATION:    _______ YES     or     ______ NO
 

IF YES, NAME OF THE ORGANIZATION: ______________________________________
 

CURRENT RANK/TITLE: __________________________/________________________

TIME IN MARTIAL ARTS: __________________________________________________

TIME IN CURRENT GRADE: ________________________________________________
 

TIME IN HUNGARIAN BUDOKAI INTERNATIONAL: ______________________________

PROMOTION RANK (if applicable): __________________________________________
 

PERSONAL REFERENCE NAME: _____________________________________________

RELATIONSHIP: _______________________ PHONE: __________________________

NEW MEMBERSHIP (HBI ONLY) -------------------------------------- FREE

NEW MEMBERSHIP  (HBI & ABI) ------------------------------------- $30.00

ANNUAL RENEWAL MEMBERSHIP (HBI & ABI) ----------------------- $30.00

DAN GRADE PROMOTION & CERTIFICATE OF RANK (ABI Only) ------ $150.00

CERTIFICATE OF TITLE (Presently in ABI Only) --------------------- $100.00

SCHOOL AFFILIATION CERTIFICATE (Presently in ABI Only) -------- $75.00

KYU PROMOTION & CERTIFICATE OF RANK (ABI Only) --------------- $25.00

ADDITIONAL ABI 3" EMBROIDERED "EAGLE & SWORD" PATCH ------ $8.00

SHINTOYOSHINKAI RECTANGULAR JIU JITSU SLEEVE PATCH -------- $8.00

PAYMENT INFORMATION
 

IMPORTANT!
You can pay with Credit Card, - only if you are planning to be a member of HBI & ABI in the same time. * Please, do NOT send cash! Check or Money Order (including International) ONLY!


PLEASE REMIT PAYMENT TO: _______________________________________

CREDIT CARD PAYMENT:     _________ YES   or   ________ NO  

* (Applicable only if both organization n is involved)

AMERICAN BUDOKAI INTERNATIONAL  ___Visa   ___MC  ___Am. Ex.

                                                               ___Money Order  ___Check

CARD HOLDER NAME: __________________________________________

Account #___________________________ Exp. Date: ______________

Date: ______________ 

Amount Paid:   (USD)$ __________________

IF YOU PAY WITH CHECK OR MONEY ORDER, YOU CAN SEND IT TO THE ADDRESS BELOW:

HUNGARIAN BUDOKAI INTERNATIONAL
Attn: American Budokai International 

(*Name written on Check or Money Order)
P.O. Box 50774
Sarasota, FL 34232
U.S.A.    

APPLICANTS SIGNATURE: _________________________________________

INSTRUCTORS SIGNATURE: ________________________________________

YOUR MEMBERSHIP PACKET (if your application is also subject to ABI), - INCLUDING CERTIFICATE AND PATCH WILL BE MAILED AS SOON AS YOUR APPLICATION RECEIVED.

* The Official Language of the HBI is English and We Also Communicate in Hungarian