• MEMBERSHIP APPLICATION

  • APPLICANT INFORMATION

  • Current Street & Suburb address (your membership card and Member's Page password will be sent to this address):
  • KyuDan 
  • EMERGENCY CONTACT

  • DECLARATION

  • *Typing your name here constitutes signature
  • (only required for new memberships)
  • *Typing your name here constitutes signature
  • (if applicant is under 18 years)
  • PAYMENT DETAILS FOR ANNUAL MEMBERSHIP

  • The chief instructor of Yuishinkai Australia, Peter Kelly, as Maruyama Sensei’s representative, has requested that all payments for annual membership be made into the account below:
  • PLEASE PAY THE FEE TO THE ACCOUNT BELOW BY BSB:
    Account Name: Peter Kelly
    BSB:  633-000
    Account: 145 094 249
    Description: Membership "your name here"

*We Respect Your Privacy & Information