Grand Master Jerry Piddington's
A-K-A-N-A Membership Application
School Charters/Individual Memberships/Rank Certificates
  Please type name & rank as preferred on certificate:
First Name:
Middle Initial:
Last Name:
Email 1:
Email 2: (as applicable)
Email 3: (as applicable)
Age:
Date of Birth:
Gender: Male:  Female:
Home Phone:
Mobile Phone:
Mailing Address:
City:
Province/State:
Postal Code/Zip Code:
Training Time-In:
Rank (Kyu or Dan/Belt):
Style of Martial Arts:
Instructor's Name:
Name of  Dojo
Dojo Phone
Dojo Street Address:
Dojo City:
Dojo Province/State:
Dojo Postal Code/Zip:



Membership Information
 Click here for instructions

Please click appropriate boxes:

Yearly AKANA School Charters & Renewals:   
Associate (AOS)   Affiliated (all styles)
  School Charter (includes 11 x 17 AKANA school charter certificate) - $150
  School Charter Renewal (due by March 31) - $150.00 / Add reinstatement fee after April 30 - $25
      

 

AKANA SCHOOL CHARTERS


AKANA Individual Membership Investment & Renewal Fees:
 New Membership   Black Belt Renewal - $60.00
  Mudansha/under Black Belt (AKANA membership certificate) - $30
  Yudansha/ New Black Belt (includes AKANA patch & membership certificate) - $100
       (New membership requires copy of current rank certificate with a current photo)
2009 AKANA Memberships

AKANA Rank Certificates:  (Must be a current AKANA member)
(Associate American Open Style or Affiliate Rank Recognition)
  Kyu Belts, below Black Belt (includes 8½ x 11 AKANA certificate) - $15
  Shodan/1st Degree Black Belt (includes large 11 x 17 AKANA certificate) - $100
  Nidan/2nd Degree Black Belt (includes large 11 x 17 AKANA certificate) - $200
  Sandan/3rd Degree Black Belt & up (includes large 11 x 17 AKANA certificate) - $300       

Date Promoted:    Rank (Kyu or Dan/Belt Color):
AKANA Rank Certificates

  Please add extra charge for custom computerized calligraphy on Kyu rank certificate - $50.00
 (These Kyu rank certificates will be the same size and quality as the Dan certificates)


Additional AKANA Patches:(CLICK HERE)
   Please send additional beginner (red tomoe on white) AKANA patch(es)
   Please send additional intermediate (blue tomoe on white) AKANA patch(es)
   Please send additional advanced (white tomoe on blue) AKANA patch(es)
   Please send additional black belt (white tomoe on red) AKANA patch(es)
 @ $10 each per AKANA patch requested.

AKANA Patches

Please print and mail application and current photo along with check or money order:
AKANA / P.O. Box 571 / Denver, North Carolina  28037

Shihan - Student Enrollments!

About A-K-A-N-A


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For more information about AKANA
Call:  1-704-483-9471