Become our Member - Irish Judo Association

Name*

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Address*

Street Address Address Line 2 City County ZIP / Postal Code

Date of Birth*

Email*

Phone*

Mobile No:

Please tick which applies: JUNIOR DAN GRADES MUST APPLY FOR SENIOR LICENCE

Licence Type:*

Membership*

New Member
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Under 18's Parent/Guardian Section

The section below to be completed by Parent/Guardian if applicant is under 18 years of age.

Parent/Guardian's Name

First Last

Parent/Guardian's Email

Parent/Guardian's Phone

This information may be used to keep parents/guardians up to date with events, offers and general information regarding Judo and will not be shared with any third parties. If you do not wish to receive any information electronically please tick the box below.

I wish not to be contacted by email

To be completed by Applicant / Parent / Guardian

Declaration*

I agree to the declaration

I certify that to the best of my knowledge & belief the foregoing details are correct. I undertake to abide by the constitution & Bye-Laws of the Irish Judo Association together with any amendments that may be made during my period of membership. Please note the policy of ‘No Licence - No Insurance - No Judo’ is in force & cost of personal accident insurance is included in the above categories. Personal information gathered for the purpose of individual membership is handled in accordance with the requirements of the Data Protection Act. I further confirm that I am not a member of any other Judo Federation. I will adhere to the Irish Anti-Doping rules.

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Membership

Application for Individual Membership 2017

All renewal memberships become due the 1st of January each year

Under 18's Parent/Guardian Section

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