Become our Member - Irish Judo Association

Name of Member*

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Address*

Street Address Address Line 2 City County ZIP / Postal Code

Date of Birth*

Gender*

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Photo

(please supply for inclusion on Licence - head shot only plain background)

Phone*

Mobile No:

Email*

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

Membership Type:*

Membership*

New Member
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Club - Please Select Club from below:*

Membership No.

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

I wish not to be contacted by email

To be completed by Applicant / Parent / Guardian

Declaration*

I agree to the declaration & consent

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. I further confirm that I am not a member of any other Judo Federation. I will adhere to the Irish Anti-Doping rules. Consent: Personal information gathered from memberships are used for the sole purpose of promoting the sport of judo. This information may be used to keep clubs/parents/guardians up to date with events, offers and general information regarding regulation and promotion of Judo. Direct Marketing is not undertaken by the Association. Personal Data is handled in accordance with the requirements of the GDPR. Privacy Statement is available at www.irishjudoassociation.ie

Licence Type

Total

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Membership

Application for Individual Membership 2019

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

Under 18's Parent/Guardian Section

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