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Name of Member*
First Last
Address*
Street Address Address Line 2 City County ZIP / Postal Code
Date of Birth*
Day
Month
Year
Gender*
- Male
- Female
- AFAB Redefined/Non Binary – Assigned Female At Birth
- AMAB Redefined/Non Binary – Assigned Male At Birth
Photo
Accepted file types: jpg, Max. file size: 5 MB.

(Please supply for inclusion on Licence - Head shot only - Plain background - .jpg files only)
Phone*
Mobile No:
Email*

Under 18's Parent/Guardian Section
If the person applying for membership is under 18 years old, the parent or guardian should fill out the section below with their own information.
Parent/Guardian's Name
First Last
Parent/Guardian's Email
Parent/Guardian's Phone
- I wish not to be contacted by email
Consent
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. 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
Anti-Doping Statement*
- I agree to the following Anti-Doping Statement
Statement: I will adhere to the Irish Anti-Doping rules. I declare that I am currently not serving a Doping Ban from any sport. I note I must contact the Irish Judo Association should I have an Anti Doping Rule Violation from any sport. If I cannot agree to this declaration, I will contact the Irish Judo Association and understand my individual membership may not be accepted if an Anti Doping Rule Violation exists.

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Annual Membership Payment
Total
0,00 €
Credit Card*
Card Details
Cardholder Name

Irish Judo Association

Membership Form 2026

Step 1 of 5

Membership

Under 18's Parent/Guardian Section

Consent