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Application for Individual Membership 2021
All renewal memberships become due the 1st of January each year
Membership Form 2021
Step 1 of 3
33%
Name of Member
*
First
Last
Address
*
Street Address
Address Line 2
City
County
ZIP / Postal Code
Date of Birth
*
Date Format: DD dash MM dash YYYY
Gender
*
Male
Female
Photo
Accepted file types: jpg.
(please supply for inclusion on Licence - head shot only plain background - JPG files only)
Phone
*
Mobile No:
Email
*
Membership Type:
*
Under 12 (€25)
Under 18 (€35)
Over 18's (€55)
Existing Life Member (€10)
Student (€40)
School Club (€25)
Please tick which applies: JUNIOR DAN GRADES MUST APPLY FOR SENIOR MEMBERSHIP
Under 18's Membership
Under 18's
Under 12's Membership
Under 12's
Membership
*
New Member
Existing Member
Club - Please Select Club from below:
*
Ashbourne Judo Club
Athenry Judo Club
Bushido Judo Club
Cabra Judo Club
Carraroe Judo Club
Cavan Judo Club
Coolmine Judo Club
Cork City Judo Club
Daigokan Judo Club
Drogheda Academy of Judo
Dublin University Judo Club
Ennis West Judo Club
Fudoshin Judo Club
Galway City School of Judo
Galway Judo Club
GS Judo Club
Higashi Judo Club
Inspire NI
Judo Ichi Dai
Kerry School of Judo
Kilkenny Judo Club
Killarney Judo Club
Knocknacarra Judo Club
Kodokan Ireland
Konarakai Judo Club
Leinster Judo Palmerstown Club
Lettermullen Judo Club
Limerick Judo Academy
Lion Judo Club
Lisheenkyle School Judo Club
Lumen Christi College
Lusk Judo Club
Macroom Judo Club
Model School Judo Club
Muskerry Judo Club
NUIG Judo Club
Oranmore Judo Club
Paul Cummins School of Judo
Portmarnock Judo Club
Renbukan Judo Club
Renmore Judo Club
Samurai Uladh Judo Club
Shin Gi Tai Judo Club
St Peter’s Judo Club
Swords Judo Club
The Judo Academy
UCC Judo Club
UCD Judo Club
Waterford Judo Club
Wild Geese Judo Club
Yamakwai Judo Club
Yoroi Dojo
Membership No.
Adaptive Judo
*
Yes
No
If Yes, List Disability
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
Annual Membership Payment
Total
0,00 €
Credit Card
*
Card Details
Cardholder Name
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